Remote Health Policy & Payments Lead (Medicaid/Duals)
4004 Aetna Medicaid Administrators
- Remote job
4004 Aetna Medicaid Administrators is seeking a Senior Manager, Health Services. This role plays a critical part in leading clinical and claims-focused initiatives that drive program effectiveness within Medicaid and Duals lines. The position is fully remote, with candidates eligible from anywhere in the contiguous United States. The ideal candidate will have over 5 years of payment policy experience, including certified coding. The responsibilities include ensuring compliance, managing a policy project team, and collaborating with health plan leaders. Comprehensive benefits are available. #J-18808-Ljbffr 4004 Aetna Medicaid Administrators
$83.25k - $155.51k
...Job Summary Provides lead level analyst support for health plan payment integrity activities. Partners with leaders... ...ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory... .... Responsible for documenting policies and procedures related to concept...Remote workPolicyTemporary workWork experience placementWork at office$67.9k - $149.33k
...member of the Medical Policy & Program... ...Senior Manager, Health Services plays a... ...the business by leading clinical and claims... ...management across Medicaid and Duals lines of business... ...position is fully remote and eligible candidates... ...as it relates to payment policies....Remote workPolicyHourly payFull timeTemporary workWork at officeLocal area$86.3k - $118.7k
...Dental Fraud and Waste Lead for the Humana... ...WORK STYLE: Remote/work at home. While... ...~ Knowledge of Medicaid regulations Additional... ...will be provided payment for their internet... ...their best health – delivering the care... ...Employer It is the policy of Humana not to...Remote workPolicyFull timeTemporary workFor contractorsWork from homeHome officeMonday to Friday- ...as we renew and reimagine the future of health care. Together we will achieve our... ...people and communities we serve. The Claim Payment Policy Lead is responsible for generating policy... ...the criticality of issues. Fully Remote: This role is designated by Independence...Remote workPolicyFor contractorsWork experience placementWork at office
$83.25k - $155.51k
Molina Healthcare is seeking a Lead Level Analyst to provide support for health plan payment integrity activities. You will partner with leaders to enhance financial... ...strong data analysis skills, and experience with Medicaid and Medicare programs. Competitive benefits and...Remote job- ...medical coding and Medicaid program integrity.... ...and improper payments are recovered. The... ...overseeing behavioral health and recovery spending... ...manager and is a lead. The position... ...complex health data, policies, and guidelines, and... ...in classrooms, remote settings, or recorded...Remote workPolicyContract workWork at office
- Molina Healthcare is seeking a Lead Business Analyst to enhance health plan financial performance. The role involves... ...operational initiatives for payment integrity and provider claims accuracy... ...understanding of Medicare and Medicaid programs. A competitive benefits package...Remote job
- Monitoring and Compliance Lead, Healthcare Innovations US-Remote | US-VA-Arlington |... ...challenges of health care quality, costs,... ...design, alternative payment models, and federal... ...Centers for Medicare & Medicaid Services (CMS) and... ...priorities, model goals, and policy developments. Lead...Remote workPolicyFull timeWork experience placementH1bWork at office
$83.25k - $155.51k
Molina Healthcare is seeking a Lead Analyst for health plan payment integrity in Columbus, Ohio. The role involves managing operational initiatives and... ...4 years of business analyst experience, knowledge of Medicaid/Medicare, and strong data analysis skills. This position...Remote job$75.11k - $100.98k
...Time - Permanent Remote Employment:... ...9 Department: Health Care Authority... ...Description Lead Medical Coder (MPS... ...medical coding and Medicaid program integrity.... ...identified and improper payments are recovered. The... ...complex health data, policies, and guidelines, to...Remote workPolicyPermanent employmentFull timeContract workPart timeWork at officeImmediate startFlexible hoursShift work- ...Term Care Auditor I for a fully remote position in the US. This role... ...identifying and recovering Medicaid improper payments while conducting audits and analyzing... ...skills. Benefits include health coverage from Day 1, a flexible vacation policy, and career advancement opportunities...Remote jobPolicyFlexible hours
- ...consultant to advise clients on reimbursement strategies in Medicaid and rural health. You will manage teams, ensure quality delivery of complex... ...stakeholders. The ideal candidate has a strong background in Medicaid payment strategies and payment reform. The position offers a...
$100k - $115k
BerryDunn is seeking a Senior Consultant for their Medicaid Practice Group to improve Medicaid agency operations. This role requires 5... ...3 years with a State Medicaid agency. The position allows for remote work or working from one of the offices, with a travel expectation...Remote jobPolicy$100k - $115k
BerryDunn in the United States is seeking a Senior Consultant for their Medicaid Practice Group. This role focuses on improving Medicaid agency operations and requires 5 years of relevant experience, with a strong emphasis on project management and communication skills...Remote jobPolicy- ...is more than a job The Coder Lead will code all patient types as... ...Proficiently navigates the patient health record and other computer... ...Code of Ethics, as well as other policies and procedures in order to... ...training. * Knowledge of Prospective Payment System (PPS) methodology for...Remote workPolicyWork at officeLocal areaShift work
- ...Shield of North Carolina is looking for a Payment Integrity Ideation Lead who will drive new audit concepts and reimbursement policies aimed at reducing overpayments. The role involves... ...flex working arrangement, including remote opportunities. #J-18808-Ljbffr Blue Cross...Remote workPolicyFlexible hours
- ...will be considered for remote employment: Alabama, Colorado... ...at this time The Lead Outpatient Coder is an... ...Hire Registered Health Information Administrator... ...and Medicare and Medicaid guidelines. Proficient... ...Knowledge of organizational policies and procedures; skill...Remote workPolicyWork experience placement
$101.23k - $172.36k
...PAYMENTS FRAUD ANALYTICS LEAD WHAT IS THE OPPORTUNITY? The Payments Fraud Analytics... ...in the development of Fraud Policies and Risk Management activities... ...volunteer time Specialized health and family planning... ...otherwise indicated as fully remote, reporting into a designated...Remote workPolicyFlexible hours- ...Shield of North Carolina is seeking a Payment Integrity Ideation Lead to drive the creation of new audit... ...concepts, data models, and reimbursement policies aimed at reducing overpayments. In... ...work model with flexible on-site and remote options. #J-18808-Ljbffr Blue Cross...Remote workPolicyFlexible hours
- ...nation’s most complex health systems, O.R. TRAX supports... ..., support, payments, badges, and renewals;... ...accurately, quickly, and within policy to prevent churn or vendor... ...center operations or remote field support exposure... ...with vendor workflows. ●Leading ops inside organizations...Remote jobPolicyFull time
$70k - $90k
...intersection of data, methods, policy, and practice to... ...policy areas, from health, education, early childhood... ...alternative payment models, developing and... ...expected to: Lead or participate actively... ...Develop expertise in Medicaid data, policy, and programmatic...Remote workPolicyContract workLocal areaWork from home$86k - $105k
...Nurse Consultant for pre‑payment activities.... ...waste, and abuse in the Medicaid program.Additional duties... ...of pre‑payment review policies and guidelines that support... ...and reports related to health service utilization patterns... ...Role is 100% remote No travel obligations...Remote workPolicyFull timeWork at officeFlexible hours$101.23k - $172.36k
Payments Fraud Analytics Lead Lead the bank's fraud prevention and risk management activities... ...in development of fraud policies and risk management... ...volunteer time. Specialized health and family planning benefits... ...indicated as fully remote. #J-18808-Ljbffr City National...Remote workPolicy$79.56k - $115.72k
...Mass General Brigham Health Plan Holding... ...one of the world’s leading integrated healthcare... ...much more. The Duals Supervisor, Appeals... ...for Medicare and Medicaid Services (CMS), as... ...contractual, and corporate policies and procedures.... ...: This is a remote role with...Remote workPolicyFull timeWork at officeFlexible hoursShift work$170.45k - $243.5k
...immunology and women's health. Through our research and... .... Purpose & Scope The Lead (Director), Medical... ...limited to Payers, HCPs, policy makers, related key stakeholders... .../CMS [Medicare, Medicaid]) and solid... ...Northbrook, Illinois. Remote work from anywhere in the...Remote workPolicyWork at officeLocal areaWork from homeWorldwide- ## Regional Medicaid Lead - Southeast RegionApplylocations: Charlotte, NC... ...firm that partners with health, education, and human services... ...discussions around market shifts, policy changes, and program... ...required 25-50%This position is remote with travel/onsite requirements...Remote workPolicyH1bWork at officeLocal areaShift work
$75k
...Job Description Community Health Worker Team Lead (Riverside) at Zócalo Health... ...~ Experience working with Medicaid/Medicare ~2+ years... ...compensation Generous PTO policy including 6 paid holidays.... ...United States. We are open to remote work anywhere in the locations...Remote workPolicyWork at officeLocal areaHome officeMonday to Friday- ...doing good. Position: Lead Data Architect Location: Remote Duration: Long... ...Vermont/Dept of Vermont Health Access Data Lead - MMIS... ...models, ideally in the Medicaid or another healthcare domain... ...architecture standards, policies. Partners with data...Remote workPolicyWork at office
- Navitus Health Solutions, LLC is seeking a Senior Analyst for Government Pricing to provide advanced analytical support for Medicaid pharmacy programs. Candidates should have at least 5 years of... ...a supportive work environment. Remote work is available, with some limitations...Remote job
- Molina Healthcare is hiring a Lead Business Analyst in San Antonio, Texas to support health plan payment integrity activities. You will collaborate with operational teams and drive financial performance through operational initiatives. The ideal candidate has at least...Remote job
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