- Trinity Health (Clive, IA)
- …to extract data, generate reports, perform data analysis, and draft system/ process improvement recommendations. Prepares analyses and interprets highly complex ... and experience supporting and developing reporting and analytics for research, process improvement support and specific revenue management function. Ability… more
- Centene Corporation (Tallahassee, FL)
- …+ Provide claims operations expertise for RFPs, RFIs, and audit readiness. + Lead process improvement initiatives in collaboration with cross-functional ... matter expert (SME) for claims operations, change control, and business implementations. + Lead Claims Process Change Control, including approval of process … more
- New York State Civil Service (Albany, NY)
- …State NY Zip Code 12224 Duties Description Criminal Justice Division Medicaid Fraud Control Unit - Albany-areaDeputy Director, Electronic Investigative Support ... at ag.ny.gov/job-postings/otherThe Office of the New York State Attorney General's (OAG) Medicaid Fraud Control Unit (MFCU) is seeking an experienced IT manager to… more
- Grant Thornton (San Jose, CA)
- …assessments, and implement strategies and recommendations for business and IT process optimization, profit improvement , cost reduction, fraud prevention, ... As a Process Risk Experienced Manager, you will have the...financial oversight, quality review, and client relationship management. + Lead business development activities, including preparing proposals, managing account… more
- Humana (Springfield, IL)
- …caring community and help us put health first** The Behavioral Health Strategy Lead Behavioral Health Executive Leader (known to Humana as a Behavioral Health ... Strategy Lead role) is responsible for defining, implementing, and advancing...executives and advising functional areas on high-impact initiatives, including Medicaid innovation, 1115 Waiver integration, and CCBHC expansion. +… more
- Highmark Health (Montpelier, VT)
- …the key BU's for the Organization's value-based reimbursement programs and continuous improvement models. Lead or support key strategic initiatives across ... providers enrolled in the Organization's value-based reimbursement programs and continuous improvement models. The incumbent plays different potential roles on a… more
- Molina Healthcare (Idaho City, ID)
- …in collaboration with the clinical lead , the medical director, and quality improvement staff. + Facilitates conformance to Medicare, Medicaid , NCQA and other ... necessity. + Participates in and maintains the integrity of the appeals process , both internally and externally. Responsible for the investigation of adverse… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …compliance and/or governance on more complex special projects and audits. + Offers process improvement suggestions and participates in the solution of more ... the Food and Drug Administration (FDA), and Centers for Medicare and Medicaid Services (CMS). Provides routine interaction and coordination with the BCBS Association… more
- LA Care Health Plan (Los Angeles, CA)
- …strategic leadership and enterprise-wide oversight for organizational project management, process improvement , planning management, including Business Solutions, ... to a wide variety of audiences. Duties Enterprise EPMO Leadership + Lead the development and execution of an enterprise-wide PMO strategy with action-oriented… more
- New York State Civil Service (Albany, NY)
- …team and the Medical Director to finalize determinations from the review process .. Leading continuous improvement activities ensuring clinical quality assurance ... and clinical data to inform and enhance policies, training, and continuous improvement efforts in the service authorization process .. Consulting with OPWDD… more