- CVS Health (Springfield, IL)
- …**Preferred Qualifications:** -Preferred Illinois residency -Health plan/payor Utilization Management / Review experience. -Managed Care experience. - Medicaid ... opportunity with Aetna, a CVS Health company! Aetna operates Medicaid Managed Care Plans in multiple states: Arizona, California,...Aetna Better Health Plan of Illinois. This UM (Utilization Management ) Medical Director will be a "Work from Home"… more
- CVS Health (Trenton, NJ)
- …Checkout this opportunity with Aetna, a CVS Health company! Aetna operates Medicaid Managed Care Plans in multiple states: Arizona, Florida, Illinois, Kentucky, ... Virginia. This is a regional role that primarily supports Medicaid plans in Aetna's Northeast region but may support...may support other plans when needed. This UM (Utilization Management ) Medical Director will be a "Work from Home"… more
- CVS Health (Hartford, CT)
- …for NCQA Health Plan Accreditation, CMS Medicare Advantage, Medicare Stars, Exchange, Medicaid , and many states. HEDIS measure results are used within the enterprise ... in support of internal HEDIS reporting for high profile stakeholders such as Medicaid , Duals and Long-Term Support Services (LTSS). You will apply CVS Heart-at-Work… more
- Monroe Plan for Medical Care (Binghamton, NY)
- Case Manager II - Non- Medicaid & Health Home Summary Title:Case Manager II - Non- Medicaid & Health Home ID:HH220 (Binghamton) Location:Binghamton Job ... experiencing homelessness. In this role, you'll go beyond traditional case management - working hands-on to coordinate care, advocate for essential services,… more
- CVS Health (Austin, TX)
- …do it all with heart, each and every day. **Position Summary** **The Medicaid Senior Manager, Network Management :** * Negotiates, executes, conducts high level ... and loading contracts, agreements, amendments and/or fee schedules in contract management systems per Aetna's established policies. . * Conducts research, analysis… more
- CVS Health (Austin, TX)
- …Checkout this opportunity with Aetna, a CVS Health company! Aetna operates Medicaid managed care plans in multiple states: Arizona, Florida, Illinois, Kentucky, ... The Medical Director is part of a centralized team that supports the Medical Management staff and may support other health plans as needed. The Medical Director will… more
- CVS Health (Charleston, WV)
- …Checkout this opportunity with Aetna, a CVS Health company! Aetna operates Medicaid managed care plans in multiple states: Arizona, California, Florida, Illinois, ... Virginia plan; but part of a centralized team that supports the Medical Management staff. The Medical Director will ensure timely and consistent responses to members… more
- DATAMAXIS (IL)
- …with five (5) years of the experience working directly with/for State Medicaid agencies or equivalent supporting business initiatives through data analysis, writing ... and testing/validation of various systems. + Understanding of claims, recipient/ eligibility , and provider/enrollment data processes. + Able to create and… more
- Conduent (Helena, MT)
- …Conduent has immediate openings. This is a great opportunity to learn about Medicaid Provider support and the medical eligibility and claims process! **About ... pass a pre-employment screening and drug test + **Experience with claims management systems or HER platforms is preferred** + **Knowledge of healthcare or… more
- US Tech Solutions (Columbia, SC)
- …experience eliciting, mining, and documenting business rules, processes + 2 years Medicaid Eligibility or other healthcare insurance experience + Superb written ... data requirements and relationships. + Participating in the requirements management processes, including change control, version control, tracking and status… more