- Molina Healthcare (Dallas, TX)
- …would occur to discuss and resolve issues related to utilization management, pharmacy , quality of care, and correct coding. * Independently delivers training and ... presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty… more
- Molina Healthcare (GA)
- …+ Analysis and reporting related to Managed care data like Medical Claims, Pharmacy , Lab and HEDIS rates. + Assist Quality department with HEDIS measure deep ... dive to support HEDIS audit and revenue at risk reporting. + Calculate and track HEDIS rates for all intervention outcome and for overall markets and LOB. + Work in an agile business environment to derive meaningful information out of complex as well as large… more
- The Cigna Group (Bloomfield, CT)
- …programs. + Conduct both statistical and qualitative analyses utilizing claims, pharmacy , laboratory, and demographic data sources. + Facilitate the transition to ... digital quality measurement by adapting data workflows, analytical tools, and reporting methodologies. **Clinical Integration** + Connect clinical practice with data analytics to inform evidence-based care enhancements. + Partner with nursing and clinical… more
- BrightSpring Health Services (Englewood, CO)
- …Three (3) or more years of experience in home infusion, specialty pharmacy , intake operations, patient access, or case-management workflows. + Prior experience ... managing or leading teams strongly preferred. + Experience with CPR+, EMRs, or hospital portal systems is highly desirable. + Strong leadership and people-management skills with the ability to coach and motivate a distributed team. + Advanced ability to… more
- Henry Ford Health System (Detroit, MI)
- …care, health insurance, a full suite of home health offerings, virtual care, pharmacy , eye care and other health care retail. With former Ascension southeast ... Michigan and Flint region locations now part of our team, Henry Ford's care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation's most respected academic medical centers and is leading the… more
- The Cigna Group (Bloomfield, CT)
- …& Insight Development** + Extract and analyze data from eligibility, claims, pharmacy , lab, race/ethnicity, and 3rd party sources + Create dashboards and ... visualizations to present insights that support strategic decision-making + Perform statistical and qualitative analysis to evaluate internal/external quality initiatives + Develop queries and reports to identify non-compliant populations for outreach across… more
- The Cigna Group (Bloomfield, CT)
- …many or all of the following: Self-administered medical, dental and pharmacy product knowledge, underwriting, risk and financial analysis skills, data analysis ... and presentation, marketing processes, sales practices, account management and knowledge of administrative operations. + Strong persuasion skills and effective communicator; possesses excellent relationship-building skills both internally and externally. +… more
- Henry Ford Health System (Detroit, MI)
- …care, health insurance, a full suite of home health offerings, virtual care, pharmacy , eye care and other health care retail. With former Ascension southeast ... Michigan and Flint region locations now part of our team, Henry Ford's care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation's most respected academic medical centers and is leading the… more
- Molina Healthcare (Miami, FL)
- …financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable financial and even clinical ... insights to focus high priorities and attack underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by leveraging value-based care models.… more
- Molina Healthcare (Ann Arbor, MI)
- …(Commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy , etc.) + Experience with UNET, Comet, Macess/CSP, or other similar ... claims processing systems. + Demonstrated ability to use MS Excel/Access platforms working with large quantities of data to answer questions or identify trends and patterns, and the ability to present those findings. **Preferred License, Certification,… more