166 to 180 of 932
Understand and interpret key drivers of health care trends Conduct and evaluate studies on pricing, utilization and health care costs and manage the development of pricing methodologies and assumptions Advocate for premium changes as needed in Medicaid products to State agencies with health plan partners Mentor and develop your elite team of actuaries and help them create
Posted 5 days ago
Auditing contract loads / policy builds for adherence to quality measures and compliance standards Researching errors by comparing Account Management documentation against multiple internal systems Analytical and Researching techniques to trend or quantify projects Preparing, processing, and maintaining new group implementations and renewals Reconciling reports and group
Posted 5 days ago
Demonstrate an ability to deliver effective telephonic coaching in a manner that promotes behavior change for the NJ Developmentally Disabled population Be able to assist clients in creating a healthy vision and goals for their Health & Wellness program Participate in weekly meetings and monthly in service training Appropriately adapt telephonic coaching and education met
Posted 5 days ago
Serve as a key contributor on the IFP Product Management and Regulatory Alignment team directly supporting the Policy & Coverage Management pillar. Support Policy & Coverage Management's engagement with Regulatory, Legal, Clinical, Pharmacy and other business partners ensuring national generic COC and state specific COCs are in alignment with the regulatory environment. M
Posted 5 days ago
Coordinates, supervises and is accountable for daily/weekly/monthly activities and performance of team members Coordinates work activities with other supervisors, managers, departments, operational sites, etc. Identifies and resolves operations problems using defined processes and process improvement techniques Sets priorities for the team to ensure task completion and pe
Posted 5 days ago
Work with the engineering teams to help solve business problem Design, implement, test, deploy and maintain innovative software solutions to transform service performance, durability, cost, and security Use software engineering best practices to ensure a high standard of quality for all of the team's deliverables Write high quality distributed system software Decompose co
Posted 5 days ago
Contribute to design and implementation of programs that build positive relationships between the dental plan, providers, practice managers, and internal stake holders Proactive provider education initiatives Address high level escalated issues and communicate resolution to stakeholders Large dental prac tice auditing and contract maintenance Retention support You'll be r
Posted 5 days ago
Deliver the annual enrollment strategy, including digital assets and participate in member recruitment activities as subscribed Monitor the service model performance and details, identifying and resolving issues and prioritizing and delivering on improvements and / or engagement recommendations Understand key market and regulatory dynamics of the health insurance industry
Posted 5 days ago
Utilize internal and external data to identify opportunities to improve business performance Simplify complex data into actionable insights Business Intelligence & Dashboard Development Assist with Administration of Tableau Server and Health Plan Projects Assist with building, optimizing, and managing ETL data processing to support data integration for reporting and analy
Posted 5 days ago
Develop and deliver internal facing and client facing analytics and reporting activities, support client relationship building, and overall project management of externally focused analytic deliverables Creates and maintains end user documentation of internal and external reports (standard and custom) Identifies solutions to non standard requests and problems Solves moder
Posted 5 days ago
Develop innovative analytic solutions, create actionable insights and drive better decisions and performance to help the business achieve its business objectives Support operational analytics, reporting and process improvement data deep dive, identify and execute on new opportunities for increases in efficiencies and performance Data transformation to support front end re
Posted 5 days ago
Develop, perform and manage deliverables as it relates to financial planning, budgeting and forecasting Produce clear, well formatted reports that communicate a clear, compelling message for M&R/UHC leadership and other stakeholders Work closely with senior leadership to build and develop core financial analysis to drive decisions throughout Part D and the Medicare and Re
Posted 5 days ago
Onboard new delegated credentialing entities Conduct assessment and oversight audits of delegated entities to ensure compliance with all respective requirements (NCQA, CMS, State / Regulatory, Optum) Review and submit updates to provider system Obtain regular reports from entities Negotiate delegation agreements and work with company legal as needed Maintain and produce o
Posted 5 days ago
Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co
Posted 5 days ago
Assists in implementing and maintaining MCNA's Compliance and HIPAA programs to ensure conformity and adherence with all applicable state and federal laws and regulations Writing, developing and managing policies and procedures Collaborates with other departments to direct compliance issues to appropriate channels for investigation and resolution Interacts with all depart
Posted 5 days ago
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