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Financial/Accounting Analyst II

Horizon Blue Cross Blue Shield
Hopewell, NJ
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Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, ...
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About the job:
Connecticut or Delaware Job Summary: The Financial/Accounting Analyst II will be assigned to the Corporate Finance department and will be responsible for Financial, Planning and Analysis and/or accounting responsibilities. The position will be accountable to support the management leadership team on multiples areas of the budgeting, forecasting and accounting areas. This includes working directly with large and small divisions including but not limited to health care management, commercial business unit, government...
Location:
Hopewell, NJ
Job Type:
Full-Time
Permanent
Occupation:
Accountants and Auditors
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Certified Public Accountant
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
4
apply
Detailed Job Information

SIU Manager Fraud Investigation (Hybrid)

Blue Cross Blue Shield of Florida
Jacksonville, FL
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Job Summary This position manages SIU staff who are responsible for ...
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Summary
About the job:
complaint or case investigations involving fraud, waste and abuse allegations which are moderate to complex. This position will involve oversight functions to ensure appropriate regulatory and compliance requirements are met and high-quality outcomes are achieved. Included in responsibilities are mentoring and development of SIU staff through training and other guidance opportunities. The candidate in this position will be expected to foster strong internal and external stakeholder relationships in a collaborative manner....
Location:
Jacksonville, FL
Job Type:
Part-Time
Full-Time
Permanent
Occupation:
Compliance Managers
Career Level / Education:
High school diploma or equivalent
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
ICD-10 / ICD-9
Certified Facilities Executive
Certified Fraud Examiner
Workkeys
Applied Math
4
Graphic Literacy
5
Workplace Documents
6
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Detailed Job Information

Inter-Plan Affairs & Compliance Lead

Blue Cross and Blue Shield of Minnesota
Eagan, MN
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About Blue Cross Blue Cross and Blue Shield of Minnesota is one of the most ...
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Summary
About the job:
recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us. How Is This Role Important to Our Work? The Inter-Plan Affairs and Compliance Lead will serve as backup for the Inter-Plan Executive, a liaison for BCBSMN with the Blue Cross Blue Shield Association (BCBSA) and other Blue Plan Inter-Plan Executives (IPEs). The Inter-Plan Affairs and Compliance Lead is a business owner on...
Location:
Eagan, MN
Job Type:
Full-Time
Permanent
Occupation:
Business Operations Specialists, All Other
Career Level / Education:
High school diploma or equivalent
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Medicaid Compliance Analyst

Blue Cross Blue Shield Association
Chicago, IL
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This position enacts, monitors, and operationalizes multiple components of ...
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Summary
About the job:
the BCBSA internal compliance program, as well as the FEP Medicare Prescription Drug Program. Act as liaison with third party compliance help line vendor; investigate potential internal BCBSA compliance issues. Develop internal training programs to ensure compliance with regulatory requirements. Support Medicare Compliance Officer by: maintaining current CMS policies; ensure various HHS contract requirements met, including the training/tracking of all new and current applicable employees and FEP BOM members;...
Location:
Chicago, IL
Job Type:
Full-Time
Permanent
Occupation:
Compliance Officers
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Procurement Specialist, Hybrid Remote in Lansing, MI

Blue Cross Blue Shield of Michigan
Located in Ohio
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Position Location: Lansing, MI Hybrid Remote The primary focus of the ...
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Summary
About the job:
Procurement Specialist is to provide the day-to-day monitoring of relationships/partnerships to ensure the effectiveness of programs or services that are conducted by vendors. The Procurement Specialist also conducts due diligence on vendors by ensuring accuracy of the products/services delivered, monitoring performance and compliance with the contract terms, compiling scorecards, auditing and paying invoices and conducting performance evaluations. RESPONSIBILITIES/TASKS: - Monitor vendor performance standards and service...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Purchasing Agents, Except Wholesale, Retail, and Farm Products
Career Level / Education:
High school diploma or equivalent
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Accredited Purchasing Practitioner
Certified Purchasing Manager
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Senior Pharmacy Benefit Manager Operations Analyst

Blue Cross and Blue Shield of Minnesota
Eagan, MN
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About Blue Cross Blue Cross and Blue Shield of Minnesota is one of the most ...
Details
Summary
About the job:
recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us. How Is This Role Important to Our Work? The PBM Operations Analyst Sr. will focus on establishing and refining operational processes related to CMS and State requirements for Medicare and Medicaid products. This position will develop an oversight structure of the Pharmacy Benefit Manager(s) (PBM), departmental and key...
Location:
Eagan, MN
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
Career Level / Education:
High school diploma or equivalent
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

RN I-NICU-Medicaid-Care, Case and Disease Management

Horizon Blue Cross Blue Shield
Hopewell, NJ
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Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, ...
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Summary
About the job:
Connecticut or Delaware Job Summary: This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management. Responsibilities: - Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay. - Evaluates the...
Location:
Hopewell, NJ
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Associate's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Certified Registered Nurse
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

RN I

Horizon Blue Cross Blue Shield
Newark, NJ
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Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, ...
Details
Summary
About the job:
Connecticut or Delaware Job Summary: This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management. Responsibilities: - Assesses patient's clinical need against established guidelines and/or standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay. - Evaluates the...
Location:
Newark, NJ
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Associate's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Certified Registered Nurse
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Coordinator, Managed Care I

Blue Cross Blue Shield Of South Carolina
Lexington, SC
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Summary Reviews and evaluates medical or behavioral eligibility regarding ...
Details
Summary
About the job:
benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, coordinate, monitor, and evaluate medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes. Description 50% Performs...
Location:
Lexington, SC
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Associate's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
National Committee for Quality Assurance
Certified Registered Nurse
Licensed Master Social Worker
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Case Manager (RN) I/II/II - Safety Net

Excellus Blue Cross Blue Shield
New York, NY
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Excited to grow your career? We value our talented employees, and strive to ...
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Summary
About the job:
help employees grow professionally. If you think the open position you see is right for you, we encourage you to apply! Job Description: Summary: Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member’s case assignment. Uses a systematic approach to identify members...
Location:
New York, NY
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Associate's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Certified Registered Nurse
Registered Dietitian
National Committee for Quality Assurance
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information
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Salary: High Income Jobs ($80K-$99K)
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