Molina Healthcare jobs

Responsible for the strategic development and administration of contracts with State and/or Federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide health care services to low income, uninsured, and other populations. Knowledge/Skills/Abilities Performs government contracts activities including maintenance of state correspondence and regulatory databases, communication of deliverables/submission between staff and governmental agencies, policy and procedure maintenance and review, and contract review. Maintains calendar and databases documenting regulatory filings, approvals of member materials, member/provider inquires and ad hoc regulatory requests. Responds to inquiries from government agencies regarding plan issues and requirements. Coordinates with other departments in resolution process. Maintains log to ensure prompt and timely resolution. Conducts research on government program and state requirements as needed. Helps maintain Government Contracts SharePoint site to store regulatory correspondence/reports/materials and ensure accessibility of information to staff. Job Qualifications Required Education High School diploma or equivalent Required Experience 2+ years experience in a managed care environment, preferably in Medicaid environment. Knowledge of state Medicaid Policies and Programs. Required License, Certification, Association N/A Preferred Education Bachelor's Degree in Business Administration, Healthcare or related field. Preferred Experience 2+ years compliance related experience. 1+ years in Medicare. Preferred License, Certification, Association N/A To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. #PJHPO #LI-AC1

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. This is an essential role for the business with a significant impact on customer experience and financial well-being. The Analyst is responsible for resolving all customer inquiries regarding reimbursement issues related to our Central Pay service in a close collaboration with customer service and field engagement teams and leadership. This individual is also responsible for execution of risk-mitigation reimbursement holds, creation of customer-facing and internal reporting, central pay activity research and making all necessary pharmacy updates in the system, ensuring accuracy and completion of pharmacy and reimbursement activity information. Decisions by this associate will impact McKesson reputation, revenue, customer retention, legal risk/activity, McKesson financial obligations and millions of dollars of organizational, bad-debt risk. To be successful, this must be a highly motivated professional with exceptional attention to detail, analytical, planning, collaboration, and communication skills Key Responsibilities Customer Support Responsible for the timely resolution of customer research tickets to address questions and/or concerns related to daily payments made by PSAO from PBMs participating in the central payment program. The resolution of these tickets will require extensive analysis of internal customer data sets, using tools such as SQL/PLSQL and Excel, while applying applicable contract language, understanding of Managed Care and feedback from PSAO external PBM partners. Responsible for responding to ad-hoc customer report requests related to PSAO central payment program, using tools such as SQL/PLSQL and Excel, and communicating analysis of data to Internal Stakeholders to allow for successful follow-up with the customer PSAO Central Pay Management Assist with tasks related to the management of effective rate contracts including reviewing terminating customers and their financial risk post-membership. Regularly reviews customer Audit notifications from PBM partners and bankruptcy notifications to determine when additional action is needed from the business to reduce risk. Manage company financial obligations by regularly reviewing incoming money for terminated customers and collecting against previous balances that have been written off. Prepares reports for Pharmacy Investigation Committee meetings by researching and reviewing pharmacy payment history and risk to assist the committee in making decisions on customer relationships. Responsible for remitting payment to PSAO Central Pay vendors in timely fashion to ensure satisfaction of contractual obligations. Completes audits of membership and bank records to ensure accuracy and validity of data. Assist in the development of new processes and procedures related to PSAO Central Pay Risk Management. Business Continuity Develops, implements, and maintains risk management policies and procedures to ensure organizational compliance, operational efficiency, and alignment with regulatory requirements. Regularly reviews and updates existing policies to reflect changes in business processes, industry standards, and applicable laws. Maintains document repository of policies and procedures for PSAO Central Pay Primary back-up for Senior Risk Management Analyst - The Analyst will be cross-trained in various time-sensitive and high-visibility tasks and act as the primary back-up to the Senior Risk Management Analyst. These two positions will work very closely to ensure no gaps in responding to escalated customer issues. These tasks can be wide and varied with limited training. Business improvement Support training of Pharmacy Engagement Team members by facilitating the exchange of training material related to PSAO Central Pay with Pharmacy Engagement Senior Trainer in a timely manner Execution of projects to drive continuous improvement within the Operations Department, including significant involvement in the development of a new payment and data processing application by providing insight into current business processes and feedback to developers Minimum Requirement Degree or equivalent and typically requires 4+ years of relevant experience. Education 4-year degree in accounting or related field or equivalent experience Critical Skills 4+ year experience in accounting, finance, finance analytics or similar experience Advanced MS Excel Proficiency (v-look ups, pivot table, functions, data manipulation, etc.) Strong SQL Query Proficiency. Fundamental accounting methodologies and practices experience. Exceptional analytical skills - researching customer issues, analyze data anomalies and root cause. Strong understanding of X12 standards used in 835 file format. Excellent communication skills while explaining complex problems. A self-starter and problem solver, persistent and goal oriented. Specialized Knowledge/Skills Expertise in MS Office--Excel, Word, PowerPoint, Visio; SQL database and queries. Customer-oriented with strong ability for trouble-shooting and issue resolution. Knowledge of managed care, from a retail pharmacy or PBM perspective, a plus Must be flexible and thrive in a fast-pace environment with the ability to work on multiple tasks simultaneously Physical Requirements / Working Conditions Remote work experience This description is general in nature and is not intended to be an exhaustive list of all responsibilities. Other duties may be assigned as needed to meet company goals. Candidates must be authorized to work in USA. Sponsorship is not available for this role. We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. Our Base Pay Range for this position $76,900 - $128,100 McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. A Central Fill Pharmacy is a high-volume facility that supports multiple retail pharmacies by preparing and packaging prescription medications in one centralized location. As a member of the inventory team, you would play a key role in the operation by receiving, organizing, and putting away pharmaceutical inventory. This ensures that medications and supplies are accurately stocked and readily available for automated dispensing systems, helping the pharmacy run efficiently and safely. Target Pay: $19-25hr (based on individual experience) Job Requirements/Responsibilities: Perform inventory management functions, when necessary, such as order filling, receiving, cutting cases, product put-away, process store credit returns, expired/damaged product returns, reconciliation processing, cycle count process, processing shipping and returns to the Distribution Center, product additions and subtractions. Process inventory workflow of facility in accordance with daily goals and functions Adherence and compliance to policies, Standard Operating Procedures (SOP's) and Safety guidelines of facility Communicate with peers and supervisors about operational concerns, assist in resolving these concerns and issues as they arise. Execute planned work assignments as assigned and needed Comfortable using a computer. Knowledge of Microsoft Office suite preferred. Adhere to and promote the company's I2CARE/ILEAD Principles Ability to work independently and in small teams Any other assigned tasks Minimum Qualifications: High School Diploma or equivalent Typically requires 1+ years of related experience. Self-starter Ability to execute physical tasks, lifting up to 30lb cases of product during the first 2-3 hours of the shift Must be computer proficient Must meet company established attendance requirements and guidelines. Additional/Preferred Qualifications: Central Fill production and/or previous receiving or inventory warehouse experience preferred Knowledge/familiarity with production and inventory functions and/or background preferred 1+ years in inventory receiving highly preferred Material Handler experience is highly advantageous and preferred Physical Requirements (Lifting, standing, etc.) Standing and walking frequently throughout shift Ability to perform lifting (weights based on product)-Pallet jacks, bending, reaching Must be able to work mandatory overtime Job Hours Shift: 1st shift Hours: Monday & Friday 8:00AM - 4:30PM Tuesday/Wednesday/Thursday 7:00AM - 3:30PM Mandatory Overtime as needed (This description is general in nature and is not intended to be an exhaustive list of all responsibilities. Other duties may be assigned as needed to meet company goals. Hours and responsibilities are subject to change based on the business need) Internal applicants please note: Must not currently be on progressive discipline - written or final written warning. Must be a current McKesson employee who has the completed 90 day probationary period. Please note: If you are still in your probationary period and are interested in this position, please see your supervisor. Your application will be considered if no eligible internal candidates apply. If you have been promoted or transferred into your current position, you should have performed those duties for at least six months to be eligible for consideration. Criteria that is part of the selection process: qualifications, merit, experience and attendance and work record. We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

**Become a part of our caring community and help us put health first** The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Care Manager, Telephonic Behavioral Health 2 is a **Licensed, Masters level, Social Worker** who functions as a Support Social Services associate (Support SS) in our Special Needs Plan (SNP) program and serves as part of an interdisciplinary care team member working with other disciplines, such as nurse care managers, dieticians, behavioral health, and pharmacists to help promote and support member health and well-being. This role requires the use of structured assessments along with critical thinking skills to determine appropriate interventions such as care coordination, health education, connection to community resources, full utilization of benefits and advocacy. This role requires effective and professional communication with providers, community resources, and other members of the interdisciplinary team to address member needs. The Support SSs daily job duties include making outbound call attempts to members with social determinants of health (SDOH) needs to assess and assist with coordinating care with available plan benefits and/or appropriate community resources in a telephonic, call center, work from home environment. This role does not carry a caseload but may require additional member follow-up to ensure that all needs have been assessed and addressed. The Support SS may also receive inbound calls from members needing additional assistance. This role is also responsible for assessing the member to determine if a referral to any other discipline is needed depending on member's individualized needs. Creating and updating member care plans may be required. Documentation in the member's record is required to ensure CMS compliance, and accurately reflect work with members, providers, and other members of the interdisciplinary care team. **Use your skills to make an impact** **Required Qualifications** + Master's degree in social work from an accredited university + Current, unincumbered, social work license; **LMSW, LCSW, LICSW** + Must have passed ASWB Exam (Master, Advance Generalist, or Clinical level) + Minimum 3 years of experience working as a social worker in a medical healthcare setting + Proficient in Microsoft applications including Word, Outlook, Excel + Capacity to manage multiple or competing priorities including use of multiple computer applications simultaneously + Must be willing to obtain/maintain social work licensure in multiple states, based on business need **Preferred Qualifications** + Experience working with geriatric, vulnerable, and/or low-income populations + Licensure in LA, MD, MI, MS, NV, NM, OK, VA + Bilingual English/Spanish + Bilingual English/Creole + Experience working with Medicare and Medicaid **Additional Information** **Work-At-Home Requirements:** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **Social Security Notification:** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. **HireVue Interview Process:** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. **Benefits Day 1:** Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including: Health benefits effective day 1 Paid time off, holidays, volunteer time and jury duty pay Recognition pay 401(k) retirement savings plan with employer match Tuition assistance Scholarships for eligible dependents Parental and caregiver leave Employee charity matching program Network Resource Groups (NRGs) Career development opportunities **START DATE after completion of background/onboarding-** *Projected start dates for these positions will be throughout Feb 2026 with all interviews being conducted Dec/Jan **Schedule:** + Hours for this position are Monday - Friday 9:30am - 6pm EST. + Hours for the first 2 weeks of training are M-F 8:30am-5pm EST Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $59,300 - $80,900 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-21-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

The Director of HIM is responsible for developing, administering, and managing systems related to health information management services and revenue cycle management functions at a facility/facilities level that support and comply with the Corporate directives. This position serves as a Subject Matter Expert (SME) in health records maintenance, health records processing, electronic health record systems, EHR management, clinical documentation guidelines, HIPAA Privacy and Security, Release of Information, chart completion/delinquency process, transcription, coding and reimbursement, regulatory compliance, and revenue cycle management. The Director of HIM evaluates operations and technology continuously and recommends changes and methods for improving processes and is accountable for ensuring that policies and procedures are consistently administered efficiently and effectively to manage health information and health information services. This position serves as an advocacy for privacy and confidentiality of health information and ensures compliance with related regulations and standards established by State, Federal, accrediting, and other regulatory agencies. Customer and Employee Satisfaction: Develops positive customer relationships by displaying professional and helpful behaviors, as well as mutual respect for patients, physicians, team members, visitors, and family/significant others. Communicates openly and honestly; following through with assignments; behaving in a fair and consistent manner; and supporting teamwork at all levels of the organization. Health Information Management: Directs plans, develops, and implements systems for documentation, storage, and retrieval of health record information in accordance with accrediting/ regulatory and Conifer requirements. Assists HIM OPS Market Director to develop, implement, and assess long-range and short-term goals; conducts studies and analyzes reports and makes recommendations concerning staffing, organization, budget, and workflow. Monitors local/national trends and legislation in health information management and adjusts HIM processes accordingly Directs, plans, organizes, monitors, and evaluates the work assignments of direct reports to ensure effective and efficient operations and compliance with established standards, rules, and regulations Collects, analyzes and enters data/documentation for all required reporting in a timely manner and prior to deadline. Privacy/Confidentiality/Release of Information Directs and evaluates compliance to privacy, information security, and confidentiality of health information standards throughout CRI and reports known exceptions Ensures compliance with related regulations and standards established by State, Federal, accrediting, and other regulatory agencies. Monitors completion of required compliance, privacy, information security, and other mandatory training in a timely manner prior to deadlines. Data Collections Systems: Confidentiality/Release of Information Directs and coordinates development and implementation of systems necessary for timely and accurate collection of clinical revenue integrity data and statistical information Monitors HIM operations performance through dashboards, productivity standards, and benchmarking against peer organizations. Provides support in generating KPI reports, monitoring trends and taking action to address/resolve identified issues Electronic Medical Record (EMR) and Legal Medical Record Assessment Mechanisms Directs evaluation, selection, and implementation of systems and/or system enhancement/redesign to effectively meet department and organization requirements and goals while complying with the Nationally established guidelines. Determine EMR best practices; revise and implement policies and procedures; follow up on action plans and modify workflows as needed to achieve consistent high quality outputs from HIM Operation areas. Fiscal Management Responsible for HIM OPS/Market financial budget and staffing plan Manages HIM operations to budget and resolves variances Develops annual capital budget and long term capital plan that include new technologies to obtain productivity efficiencies and cost savings Revenue Management Effectively manages the DNFB report on a daily basis Identifies HIM OPS responsibilities and addresses on a daily basis Monitors, evaluates, areas outside of HIM that are negatively impacting DNFB/DNFC and addresses options for resolution to assist in management of the DNFM/DNFC. Personnel Management Effectively recruist, develops, and retain qualified staff Coachs and mentors staff in order to improve performance, meet productivity standards and expand responsibility Identifies talent and actively develops skills to support the functioning of the department Monitors, evaluates, appraises, or disciplines employees' activities according to organizational guidelines. Management of Information Standard Administrative Responsibility Directs and coordinates maintenance and compliance of The Joint Commission, Medicare Conditions of Participation, and DNV requirements/standards related to information management and medical record documentation and content. FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense): Annual budget: up to 3.5 million SUPERVISORY RESPONSIBILITIES If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Direct Reports (titles) HIM Managers, HIM Supervisors Indirect Reports (titles) HIM Specialists To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable consideration may be given to other candidates per Senior Management discretion. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Understanding of HIM processes in an electronic health record environment with ability to research, design, and implement best practices Advanced knowledge of The Joint Commission, Medicare Conditions of Participation, and DNV requirements related to information management and medical record documentation and content; proficiency in interpreting and implementing measures to comply with these requirements Ability to effectively interpret and apply organizational policies, procedures, and systems Ability to handle multiple complex assignments Demonstrated knowledge of multi-department and cross-functional project planning, project management and change management Ability to identify and resolve problems of varying degrees of complexity using strong analytical and logic skills Ability to troubleshoot, isolate, and lead resolutions of issues Advance knowledge of compiling and reporting statistical data Ability to develop and maintain positive relationships with direct reports, corporate leadership, and hospital/medical staff leadership Ability to monitor and maintain a budget Excellent interpersonal and organizational skills and attention to detail Strong written communication and presentation skills Computer knowledge of MS Office Ability to carry out instructions furnished in written, oral, or diagram form. Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. Bachelor's degree in Health Information Management and/or closely related field and seven (7) years progressively responsible related experience to include at least three (3) years in supervisory capacity Previous successful Manager or Director level experience in hospital and/or academic hospital/health system environment with an EMR strongly preferred REQUIRED CERTIFICATIONS/LICENSURE Include minimum certification required to perform the job. Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or active participation in a higher level of education towards obtaining a RHIA or RHIT is required PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to work in sitting position, use computer and answer telephone Ability to travel Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments Duties may require bending, twisting and lifting of materials up to 25 lbs. Duties may require driving an automobile to off-site locations. WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Office Work Environment Hospital Work Environment Work environment is at a moderate level Capacity to work productively and independently in a virtual office setting or at hospital setting if required to travel for assignment. TRAVEL Up to 50% travel may be required

**Become a part of our caring community and help us put health first** The Manager, Fraud and Waste Investigator: Nurse Audit/Review performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The Manager, Nurse Audit/Review works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/Review validates and interprets medical documentation to ensure capture of all relevant coding. Identifies members with high-risk CMS Hierarchical Condition Categories (HCC) and refers cases for annual follow-up care by disease management, case management, and primary care providers as appropriate for assessment/intervention. Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management. Applies clinical and coding experience to conduct reviews of provider codes and billing. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department. **Use your skills to make an impact** **WORK STYLE:** Remote, work at home (associates can opt to work in a local Humana office). While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **WORK HOURS:** Typical work hours are Monday-Friday, 8 hours/day, 5 days/week. **Required Qualifications** + Registered Nurse (RN), holding an active and unrestricted license + Coding knowledge (CPC preferred, but not required) + Bachelor's Degree + 3 or more years of management experience in a large corporate environment with accountability of multiple teams or processes + Excellent collaboration and communication skills + Solid understanding of process / workflow concepts + Strong research, problem-solving and analytical skills + Comprehensive knowledge of Microsoft Office, Word, Excel and PowerPoint + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Master's Degree in Business, Finance or related fields + Healthcare Insurance Industry knowledge + CPC preferred **Additional Information** **Work at Home Requirements** - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested - Satellite, cellular and microwave connection can be used only if approved by leadership - Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $86,300 - $118,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-14-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. We are seeking a highly skilled and strategic Senior Manager, Quality Packaging Engineer, to lead the development, validation, and implementation of cold chain packaging solutions across our distribution network. This role ensures that all temperature-sensitive products are packaged and transported in compliance with industry standards and internal quality requirements. Key Responsibilities Oversee a team responsible for the design, validation, and deployment of new and existing cold chain packaging solutions while ensuring appropriate change management. Lead a team to support network-wide changes and initiatives related to cold chain packaging and transportation controls. Collaborate cross-functionally with Enterprise Quality, Logistics, Operations, and external packaging solution providers to ensure alignment and successful implementation of new or revised packaging solutions. Monitor and ensure correct packaging solutions are utilized at Distribution Centers (DCs). Manage vendor relationships and evaluate new technologies and materials. Lead updates and maintenance of SOPs and work instructions related to cold chain packaging. Provides coaching, mentoring, and performance management to team members, fostering a culture of continuous improvement and innovation. Champions talent development and succession planning within the packaging team. Minimum Requirement Degree or equivalent experience. Typically requires 9+ years of professional experience and 1+ years of supervisory and/or management experience. Education Bachelor's degree in engineering, Life Sciences, or a related field (master's preferred). Critical Skills 8+ years of experience in Engineering or Quality roles, preferably in pharmaceutical, biotech, or food industries. 3+ years of experience with direct responsibility for overseeing cold chain packaging programs Strong knowledge of ISTA standards and validation protocols. Proven experience managing cross-functional projects and driving network-wide initiatives. Excellent communication, organizational, and leadership skills. Experience with SOP development and regulatory compliance. Leadership Experience Requirements Minimum of 5-7 years of progressive leadership experience, preferably within pharmaceutical or life sciences packaging, with a focus on cold chain logistics. Proven track record of leading cross-functional teams in a regulated environment. Demonstrated ability to develop and execute strategic initiatives while managing operational priorities. Specialized Knowledge & Skills Knowledge of FDA and other regulatory agencies. Knowledge of wholesale distribution and/or pharmaceutical manufacturing. Excellent written and verbal communication skills. Strong analytical skills. Working Conditions Environment (Office, warehouse, etc.) Able to travel 40% of the time. Remote work environment - Work from Home. Physical Requirements (Lifting, standing, etc.) Using keyboard/laptop 8 hours a day Candidates must be authorized to work in USA. Sponsorship is not available for this role. We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. Our Base Pay Range for this position $109,500 - $182,500 McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. Key Responsibilities: Pick, pack and ship prescriptions directly to retail pharmacies and end-customer in a fast-paced semi-automated production environment. Ability to fill, pack and ship prescriptions with 100% accuracy and efficiency using Standard Operating Procedures (SOP) and McKesson supported hardware and software. Able to read computer generated screens, find indicated merchandise on labeled shelves, and verify quantity and dosage of the product before selecting for order. Examines stock and distributes materials in inventory. Also responsible for maintenance and housekeeping, proper storage of goods, ensuring correct reliable shelf labels for merchandise locations, and other duties as assigned. May require mandatory overtime based on business need. Minimum Requirements: Typically requires 1+ years of related experience Critical Skills: 0-1 years of proven experience with excellent attention to detail 0-1 years' experience in a quality focused role Additional Qualifications/Job Information: Excellent attention to detail Quality focused Physical Requirements: Able to select and lift objects from shelves and carry to order filling line. Able to consistently carry 20-30 lbs. of merchandise short distances and 15 lbs. of merchandise on an extended basis from order filling station to conveyor. Must be able to walk and stand throughout the entire shift. Pay: $18.00/hour plus $1.00/hour shift differential Work Schedule: Full time, 40 hours a week Sunday to Thursday 2pm to 10:30pm Internal Applicants: Must meet established attendance requirements. Must not currently be on progressive discipline - written or final written warning. Must currently maintain acceptable standards and quality in present position. Current McKesson employee who has completed 90 day probationary period . Please note if you are still on your probationary period and are interested in this position please see your supervisor, if no internal candidates whom have completed their probation apply then you may put in a internal application for consideration. We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria to minimize liability to the company and to maximize safety for members. This position is responsible for the initial credentialing, recredentialing and ongoing monitoring of sanctions and exclusions process for practitioners and health delivery organizations according to Molina policies and procedures. This position is also responsible for meeting daily/weekly production goals and maintaining a high level of confidentiality for provider information. **Job Duties** - Evaluates credentialing applications for accuracy and completeness based on differences in provider specialty and obtains required verifications as outlined in Molina policies/procedures and regulatory requirements, while meeting production goals. - Communicates with health care providers to clarify questions and request any missing information. - Updates credentialing software systems with required information. - Requests recredentialing applications from providers and conducts follow-up on application requests, following department guidelines and production goals. - Collaborates with internal and external contacts to ensure timely processing or termination of recredentialing applicants. - Completes data corrections in the credentialing database necessary for processing of recredentialing applications. - Reviews claims payment systems to determine provider status, as necessary. - Completes follow-up for provider files on 'watch' status, as necessary, following department guidelines and production goals. - Reviews and processes daily alerts for federal/state and license sanctions and exclusions reports to determine if providers have sanctions/exclusions. - Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of Medicare. - Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found. **JOB QUALIFICATIONS** **Required Education:** High School Diploma or GED. **Required Experience/Knowledge Skills & Abilities** - Experience in a production or administrative role requiring self-direction and critical thinking. - Extensive experience using a computer -- specifically internet research, Microsoft Outlook and Word, and other software systems. - Experience with professional written and verbal communication. **Preferred Experience:** Experience in the health care industry To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.16 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**Become a part of our caring community and help us put health first** The Senior Payment Integrity Professional uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our financial recovery. The Senior Payment Integrity Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Payment Integrity Professional contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree in Business, Finance, Healthcare Administration, Data Analytics, or a related field, or equivalent work experience. + Demonstrated experience in claims analysis, payment integrity, or healthcare data analytics, preferably within a managed care or payer environment. + Advanced proficiency in data mining tools (ie Power BI) and techniques for detecting overpayments. + Strong analytical and critical thinking skills; ability to evaluate complex data and variable factors to draw in-depth conclusions. + Ability to work independently with minimal direction, exercising sound judgment and considerable latitude in determining approaches to assignments. + Proven ability to manage and make decisions on moderately complex to complex technical issues and projects. + Effective communication and interpersonal skills, including the ability to influence departmental strategy and collaborate with cross-functional teams. **Preferred Qualifications** + Master's degree in a related field. + Experience leading people, projects, and/or processes + Experience using the following systems: CAS, CISpro and CIS + Experience with provider contract payment analysis and knowledge of payer systems. + Knowledge of relevant regulatory requirements and industry best practices in claims payment integrity. + Familiarity with audit processes and recovery operations in a payer environment. + Experience in a fast paced, metric driven operational setting **Additional Information** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-11-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

The Director of Revenue Integrity serves in a senior leadership capacity and demonstrates client and unit-specific leadership to Revenue Integrity personnel by designing, directing, and executing key Conifer Revenue Integrity processes. This includes Charge Description Master (“CDM”) and charge practice initiatives and processes; facilitating revenue management and revenue protection for large, national integrated health systems; regulatory review, reporting and implementation; and projects requiring expertise across multiple hospitals and business units. The Director provides clarity for short/long term objectives, initiative prioritization, and feedback to Managers for individual and professional development of Revenue Integrity resources. The Director leverages project management skills, analytical skills, and time management skills to ensure all requirements are accomplished within established timeframes. Interfaces with highest levels of Client Executive personnel. Direct Revenue Integrity personnel in evaluating, reviewing, planning, implementing, and reporting various revenue management strategies to ensure CDM integrity. Maintain subject-matter expertise and capability on all clinical and diagnostic service lines related to Conifer revenue cycle operations, claims generation and compliance. Influence client resources implementing CDM and/or charge practice corrective measures and monitoring tools to safeguard Conifer revenue cycle operations; provide oversight for Revenue Integrity personnel monitoring statistics/key performance indicators to achieve sustainability of changes and compliance with regulatory/non-regulatory directives. Assume lead role and/or provide direction/oversight for special projects and special studies as required for new client integration, system conversions, new facilities/acquisitions, new departments, new service lines, changes in regulations, legal reviews, hospital mergers, etc. Serve as primary advisor to and collaboratively with Client/Conifer Senior Executives to ensure requirements are met in the most efficient and cost-effective manner; provides direction to clients for implementation of multiple regulatory requirements. Serve as mentor and coach for Revenue Integrity personnel and as a resource for manager-level associates. Maintain a high-level understanding of accounting and general ledger practices as it relates to Revenue Cycle metrics; guide client personnel on establishing charges in appropriate revenue centers to positively affect revenue reporting FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense): Adherence to established/approved annual budget SUPERVISORY RESPONSIBILITIES This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Direct Reports (incl. titles) : Revenue Integrity Manager/Supervisor Indirect Reports (incl. titles) : Charge Review Specialist I-II, Revenue Integrity Analyst I-III, Charge Audit Specialist To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to set direction for large analyst team consistent with Conifer senior leadership vision and approach for executing strategic revenue management solutions Demonstrated critical-thinking skills with proven ability to make sound decisions Strong interpersonal communication and presentation skills, effectively presenting information to executives, management, facility groups, and/or individuals Ability to present ideas effectively in formal and informal situations; conveys thoughts clearly and concisely Ability to manage multiple projects/initiatives simultaneously, including resourcing Ability to solve complex issues/inquiries from all levels of personnel independently and in a timely manner Ability to define problems, collect data, establish facts, draw valid conclusions, and make recommendations for improvement Advanced ability to work well with people of vastly differing levels, styles, and preferences, respectful of all positions and all levels Ability to effectively and professionally motivate team members and peers to meet goals Advanced knowledge of external and internal drivers affecting the entire revenue cycle Intermediate level skills in MS Office Applications (Excel, Word, Access, Power Point) Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. Bachelor's degree or higher; seven (7) or more years of related experience may be considered in lieu of degree Minimum of five years healthcare-related experience required Extensive experience as Revenue Integrity manager Extensive knowledge of laws and regulations pertaining to healthcare industry required Prior healthcare financial experience or related field experience in a hospital/integrated healthcare delivery system required Consulting experience a plus CERTIFICATES, LICENSES, REGISTRATIONS Applicable clinical or professional certifications and licenses such as LVN, RN, RT, MT, RPH, CPC-H, CCS highly desirable PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit for long periods of time; use hands and fingers; reaching with hands and arms; talk and hear. Must frequently lift and/or move up to 25 pounds Specific vision abilities required by this job include close vision Some travel required WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Normal corporate office environment TRAVEL Approximately 10 - 25% Compensation and Benefit Information Compensation Pay: $104,624- $156,957 annually. Compensation depends on location, qualifications, and experience. Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level. Management level positions may be eligible for sign-on and relocation bonuses. Benefits Conifer offers the following benefits, subject to employment status: Medical, dental, vision, disability, life, and business travel insurance Management time off (vacation & sick leave) - min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked. 401k with up to 6% employer match 10 paid holidays per year Health savings accounts, healthcare & dependent flexible spending accounts Employee Assistance program, Employee discount program Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act.

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. Responsibilities: Develop and maintain effective working relationships with Physicians, Administrators, C- suite, Pharmacists, Nurses, etc. Identify potential opportunities for McKesson to deliver value to each customer in the form of differentiated and routine value. We make every effort to quantify the financial impact of the value unless we are not allowed to for business reasons. Support the development of Therapeutic Interchange meetings (TIC), Quarterly Business Reviews (QBR) and End of Quarter GPO optimization meetings with each customer. These are the routine touch points of our team with each customer every quarter. Function as the primary point of contact for McKesson Provider specialty for each customer serviced within their book of business. Collaborate effectively with internal teams, including the Onmark GPO, Clinical Specialists, Customer Success Managers, Customer Care, Medically Integrated Dispensing, Advisory Services, Finance, Pricing and Operations. This collaboration requires coordination of internal and external meetings with the subject matter experts within each McKesson Specialty support businesses. Manage a book of business effectively to achieve annual performance objectives including Gross Profit and Revenue performance to plan. In addition, there will be unique business objectives each fiscal year depending on the strategic priorities of the business and the customer needs. Effectively promote additional products and services to existing customers ensuring our wide range of support is being utilized by all eligible customers. Minimum Requirements: Enrolled as a full-time student at the time of the internship, at the Undergraduate or Graduate level Must have completed a minimum of 75 credit hours by the start of the internship 18 Years of age Authorized to work in the United States Excellent verbal communication skills required Must be self-motivated - Demonstrates personal commitment and drive to meet or exceed objectives. Must be able to identify individual customers' needs and provide solutions based on those needs Must be a team player and willing to work in a changing environment Proficient in MS Office Critical Skills: Willingness to learn, develop, and contribute in a fun, demanding, fast-paced environment. Self-starter that brings both interpersonal skills and a superior ability to identify a problem then solve it. Out of the box thinkers wanted! We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. Our Base Pay Range for this position $14.85 - $24.75 McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Location: Position is hybrid. Candidate must live in TX. Prefer candidate to live in/around Austin, San Antonio, or Dallas. Position Purpose: Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers. Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements. Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure. Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters). Identifies specific practice needs where Centene can provide support. Develops, enhances and maintains provider clinical relationship across product lines. Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards. Ability to travel up to 75% of time to provider offices. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's Degree or equivalent required 3+ years in HEDIS record collection and risk adjustment (coding) required Licenses/Certifications: One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS For Superior HealthPlan: license/certification is preferred Location: Position is hybrid. Candidate must live in TX. Prefer candidate to live in/around Austin, San Antonio, or Dallas. Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. 🌟 Join McKesson's Extended Care Sales Team! Are you passionate about making a difference in healthcare and building lasting relationships? McKesson Medical-Surgical is hiring a Field Sales Account Manager to support our Post-Acute Care customers in Mid and Southern New York. This is a remote-based role, and candidates must reside within the territory. 💼 About the Role As an Account Manager, you'll be the trusted advisor for long-term care, home health, and hospice providers-helping them access the industry's largest portfolio of medical supplies and equipment. You'll drive growth by identifying new opportunities, nurturing existing relationships, and delivering consultative solutions that improve patient outcomes. 💼 About McKesson's Extended Care Solutions Patients in long-term care, skilled nursing, rehabilitation, sub-acute care, long-term acute care, home care, and hospice settings have unique and evolving medical supply needs. McKesson offers one of the industry's most comprehensive portfolios-spanning 23 product categories including durable medical equipment, home care supplies, and oxygen equipment. Our solutions are designed to help extended care providers support better patient outcomes through reliable access to essential products and services. 💼 Compensation Transparency & Growth Opportunity At McKesson, we embrace a Pay for Performance sales culture-your results directly impact your earnings. This Post Acute Care Sales Representative role offers a base salary of approximately $100,000, with an initial sales incentive of $35,000. This incentive is a starting point for all representatives entering the role. What sets this opportunity apart is the growth potential of the Northeastern territory. With strong expansion opportunities and additional performance-based bonuses tied to new business, successful representatives can increase their total target cash compensation to $150,000 and beyond in their first year. We're looking for driven individuals who thrive in a results-oriented environment and are excited to grow a high-potential territory through relationship-building and strategic sales efforts! 🚀 What You'll Do Manage and grow a portfolio of Post-Acute Care customers Prospect and cold call to identify new business opportunities Conduct business reviews and deliver consultative sales presentations Collaborate with internal teams to ensure seamless customer support Maintain effective agreements and secure product distribution Partner with senior reps or leadership on complex accounts 🎯 What You Bring Minimum Requirements 4+ years of sales experience Must have a valid driver's license and acceptable driving record 7-year Motor Vehicle Record Check conducted during background Critical Skills Proven success selling to long-term care, home health, hospice, DME, or wound care providers Strong cold calling and prospecting abilities Demonstrated ability to grow and retain customer accounts Consistent achievement of sales goals Experience with consultative selling and business reviews Valid driver's license and clean driving record Proficiency in Microsoft Outlook, Excel, PowerPoint, and Salesforce Preferred Skills Experience in healthcare distribution Excellent verbal and written communication skills Public speaking experience a plus Organized, self-motivated, and team-oriented Eager to grow professionally and take initiative 🏡 Work Environment Home office setup with frequent travel (minimal overnight travel) Significant time spent on phone and computer-based work 🎓 Education High School Diploma required Bachelor's degree in Business or related field strongly preferred (or equivalent experience) 💡 Why McKesson? At McKesson, we're committed to improving care in every setting. You'll join a team that values collaboration, innovation, and personal growth-with the tools and support to help you thrive. We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. Our Total Target Cash (TTC) Pay Range for this position: $125,400 - $209,000 Total Target Cash (TTC) is defined as base pay plus target incentive. McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

**Become a part of our caring community and help us put health first** The Senior Cloud Solutions Engineer participates in the design and development of cloud-based solutions and applications in the big data space within Humana's Digital & Data organization primarily using Microsoft Azure and related technologies. The Senior Cloud Solutions Engineer work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Cloud Solutions Engineer implements the organization's cloud strategy from a technical perspective, including design, planning, integration, and maintenance for big data solutions using Microsoft Azure. This will involve participating in the design and development of cloud-based solutions and applications within Humana's Digital & Data organization primarily using Microsoft Azure. Responsibilities Include: + Work with stakeholders across organization to evaluate cloud systems and identify appropriate solutions. + Collaborates with product managers and engineers to develop specifications for new cloud-based products/services, applications and solutions. + Drives the roll-out of cloud management platforms, evaluates its performance and implements enhancements. Begins to influence department's strategy. + Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree in Computer Science, a related field, or equivalent professional experience. + Proven experience designing and implementing cloud-based big data solutions using Azure, AWS, or GCP. + Minimum of 6 years of experience in cloud application design, development, and testing. + At least 3 years of hands-on experience working with Databricks, Azure Data Factory, and Azure Synapse Analytics. + Proficient in ETL processes, SQL, and PySpark for data integration and transformation tasks. + Experience with version control systems (such as Git) and managing release pipelines. + Demonstrated commitment to enhancing consumer experiences and supporting continuous organizational improvement. + One or more professional certifications in Azure, Databricks, or other major cloud platforms. **Preferred Qualifications** + Master's Degree + Databricks experience + Python experience **Work-At-Home Requirements** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $106,900 - $147,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 11-18-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

The Supervisor is responsible for the supervision and leadership of the Patient Account Representatives, both on-site and telecommuters. Directly responsible for the interviewing, hiring, training, scheduling, and monitoring of staff as well as all aspects of A/R Management and Performance Management. Attend meetings and respond timely to all requests, including completion of accounts referred to the Supervisory Desk. Identify performance deficiencies and opportunities and implement action plans as appropriate. Effectively maintain a work environment which promotes communication to stimulate the morale, engagement, and growth of subordinates. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned . Responsible for all aspects of the day-to-day supervision and leadership of Patient Account Representatives, including but not limited to the Performance Management metrics of collections, productivity, quality and aging. Interview candidates and make hiring recommendations and decisions. Complete monthly quality evaluations. Monitor staff scheduling and adherence to time and attendance protocol. Responsible for all aspects of A/R Management, including but not limited to maintaining workload balance, ensuring maximum efficiency, eliminating rework, and reducing cost. Promptly identify issues and develop action plans to mitigate or resolve. Train, develop, motivate and assist subordinates in reaching new levels of skills, knowledge and attitude. Effectively maintain a work environment which stimulates and motivates the morale, engagement and growth of subordinates. Identify performance deficiencies and opportunities and implement action plans as needed. Review and respond timely to requests, including emails, telephone calls, issues, account research and resolution as needed by staff, management and clients. Timely completion of accounts referred to the Supervisory Desk by staff or management. Effectively communicate and interact with subordinates, management and clients. Conduct, attend and participate in meetings, conference calls and training sessions, including Management Meetings, Team Meetings, as well as one-on-one monthly meetings with subordinates to provide consistent performance feedback. Complete the mid-year and year end Performance Management review. SUPERVISORY RESPONSIBILITIES If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. No. Direct Reports (incl. titles) Patient Acct Reps, Sr Patient Acct Reps, Lead Patient Acct Reps KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Very good written and verbal communication skills Strong interpersonal skills Strong technical skills, including PC and MS Office Suite knowledge Proficient in building a strong team to meet performance goals Effectively manages multiple tasks Displays sound judgment and reasoning abilities Creative and innovate thinking Achieves results with accuracy and precision Advanced knowledge of healthcare A/R Excellent working knowledge of Patient Financial Services operations with specific focus on Inpatient and Outpatient Managed Care and Commercial payors (i.e., Medicare regulations and compliance; HIPAA) Proficient in Microsoft Office (Word and Excel) Advanced writing skills Ability to provide advanced customer service Ability to train and coach staff Ability to multi-task Strong leadership and organizational skills Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. High School diploma and/or equivalent education 4-7 years experience preferred Advanced knowledge of UB-04, EOB interpretation, CPT and ICD-9 codes. Supervisory experience or demonstrated leadership. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to sit and work at a computer terminal for extended periods of time WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Office/Teamwork Environment As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation Pay: $51,626.00 - $77,438.00 annually. Compensation depends on location, qualifications, and experience. Management level positions may be eligible for sign-on and relocation bonuses. Benefits Conifer offers the following benefits, subject to employment status: Medical, dental, vision, disability, life, and business travel insurance Paid time off (vacation & sick leave) - min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked. 401k with up to 6% employer match 10 paid holidays per year Health savings accounts, healthcare & dependent flexible spending accounts Employee Assistance program, Employee discount program Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act.

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you. The Pricing Solution Owner leads the team that delivers best-in-class data and technology solutions to support the PSaS Pricing organization of the future. This role is responsible for partnering with MT to propose solutions and align on the technology roadmap to deliver a scalable set of solutions for the PSaS Pricing service delivery model of the future while balancing immediate business requirements with long-term technological capabilities. Working collaboratively with McKesson Technology on behalf of the Pricing Leadership Team, this leader will ensure data and technology investments simplify processes, scale solutions, drive excellence in pricing execution and deliver measurable business value within budget and on time. Operating in a highly matrixed environment, this leader will collaborate with the Pricing Process Owner and Pricing Intelligence Team Leaders. The team will identify evolving business needs, define data standards/definitions, provide specialty maintenance and automation (AI/ML) and deliver scalable, forward-looking pricing technologies and deal lifecycle support for a $300B+ PSaS portfolio. This role reports to the Sr. Director Pricing Process and Solutions and must possess strong ILEAD (Inspire, Leverage, Execute, Advance, Develop) behaviors, business acumen, and team development skills. The ideal candidate will bring deep expertise and skills in technical frameworks and forward-thinking systems solutions, customer engagement, and project management. Key Responsibilities Drive transformation efforts specializing in technology enablement through product line model management, ad hoc PLM/system maintenance, system business requirements, UAT support, Deal Workflow solution design and development (LSS), data sets and dashboard development, demand/capacity management systems, Deal Workflow pipeline reporting tools, specialty maintenance and automation, and future technology solutions. Provide leadership and direction to a team of direct reports consisting of managers and individual contributors in a fast-paced Pricing environment, adapting to evolving business needs and priorities. Offer mentorship, support, and career development. Communicates the PSaS Pricing Transformation vision and translates it into a functional roadmap and plan for the Solution Owner team. Serve as the senior liaison between Pricing and MT teams by fostering collaboration and partnership to develop and deploy tools/systems that improve pricing frameworks, deal modeling and decision support on time and within budget. Translate business requirements into technical specifications and communicate technology capabilities/constraints back to business stakeholders. Manage expectations, resolve conflicts, and build strong collaborative relationships. Ensure Pricing solutions align with broader Pricing organizational goals. Oversee the end-to-end delivery of data and technology solutions, by guiding the Pricing Business Systems Liaisons, Data Steward and Pricing Solutions Analyst and acting as a key conduit between Pricing and McKesson Technology (MT). Lead efforts to translate Pricing business processes into system requirements and technology solutions. (e.g., PLM model). Support Pricing's transformation journey by identifying and guiding projects related to operational improvements, including: Modernizing all aspects of the Pricing technology roadmap, products/solutions, dashboards, requirements gathering and reporting by leveraging automation (AI/ML) where possible. Championing system adoption by articulating business value, operational efficiency, and maintaining accountability to timelines and service standards. Engage with and influence senior/executive stakeholders (Pricing Segment, Generics, Pricing Intelligence, Sales) to shape pricing technology strategy and frameworks Other responsibilities as assigned. Minimum Requirement Degree or equivalent experience. Typically requires 12+ years of professional experience and 4+ years of management experience. Education Bachelor's degree required, Business, Technology or related field preferred MBA or advanced degree in Business, Technology, or related is strongly preferred Certifications Product Owner and/or AI certifications is a plus Critical Skills 12+ years of relevant business system, technology solution (data, dashboards, pricing systems) development expertise 4+ years of management experience Leadership presence and acumen with the ability to engage with various audiences, influence without authority, and defend your positions Previous pricing operations exposure / background with understanding of pricing frameworks and deal lifecycle management Previous experience implementing pricing tools and systems to automate and standardize pricing processes Expertise in streamlining complex pricing structures and matrices to enhance clarity and ease of understanding for customers and internal stakeholders Effective communication and influencing skills, with the ability to translate and present complex concepts and recommendations to business audiences/leadership Project and portfolio management expertise Additional Skills Pricing operations expertise, preferably in a Fortune 100 company is a plus Industry experience in healthcare, pharmaceutical, life sciences, or large-scale B2B environments is a plus Familiar with complex customer negotiations and ability to understand, interpret and apply complex pricing frameworks Self-starter with track record of outstanding judgment and intuition Strong leadership skills including team development, managing in a matrix organization, and working with various audiences at all levels across multiple functions Demonstrated ability to motivate, influence and gain commitment at all levels of the organization Ability to organize, manage and prioritize multiple projects Working Conditions Traditional office environment Large percent of time performing computer-based work is required Salary: 136,300.00 - 181,700.00 - 227,100.00 USD Annual with 20% MIP *Starting Pay is between $160,000 to $185,000 based on skills and qualifications for this role in the Irving, Texas area M4 We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. Our Base Pay Range for this position $136,300 - $227,100 McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. Join us at McKesson!

You could be the one who changes everything for our 28 million members as an Intern at Centene. During this 12-week program, you'll learn more about Centene and how we're transforming the health of the community, one person at a time. Observe preceptors and participate in various projects to learn and develop skills related to the Managed Care industry. + Develop clinical knowledge and skills by learning about various processes and functions within the Managed Care industry + Observe processes and shadow preceptors to gain hands on experience and become familiar with various clinical services + Follow instructions and procedures provided by preceptor or manager in accordance with company guidelines **Education/Experience:** Current enrollment in an accredited clinical program. Candidates must be receiving course credit for participating in the Externship program. Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care. The SIU Investigator is also responsible for recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Officers in order to achieve and maintain appropriate anti-fraud oversight. Job Duties * Responsible for developing leads presented to the SIU to assess and determine whether potential fraud, waste, or abuse is corroborated by evidence. * Conducts both preliminary assessments of FWA allegations, and end to end full investigations, including but not limited to witness interviews, background checks, data analytics to identify outlier billing behavior, contract and program regulation research, provider and member education, findings identification and communications development, and recommendations and preparation of overpayment identifications and closure of investigative cases. * Completes investigations within the mandated period of time required by either state and/or federal contracts and/or regulations. * Conducts both on-site and desk top investigations. * Conducts low to medium, and extensive investigations, including reviews of medical records and data analysis, and makes determinations as to whether the investigation and/or audit identified potential fraud, waste, or abuse. * Coordinates with various internal customers (e.g., Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to gather documentation pertinent to investigations. * Detects potential health care fraud, waste, and abuse through the identification of aberrant coding and/or billing patterns through utilization review. * Prepares appropriate FWA referrals to regulatory agencies and law enforcement. * Documents appropriately all case related information in the case management system in an accurate manner, including storage of case documentation following SIU related requirements. Prepares detailed preliminary and extensive investigation referrals to state and/or federal regulatory and/or law enforcement agencies when potential fraud, waste, or abuse is identified as required by regulatory and/or contract requirements. * Renders provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements. * Interacts with regulatory and/or law enforcement agencies regarding case investigations. * Prepares audit results letters to providers when overpayments are identified. * Works may be remote, in office, and on-site travel within the state of New York as needed. * Ensures compliance with applicable contractual requirements, and federal and state regulations. * Complies with SIU Policies as and procedures as well as goals set by SIU leadership. * Supports SIU in arbitrations, legal procedures, and settlements. * Actively participates in MFCU meetings and roundtables on FWA case development and referral JOB QUALIFICATIONS Required Education Bachelors degree or Associate's Degree, in criminal justice or equivalent combination of education and experience REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES * 1-3 years of experience, unless otherwise required by state contract * Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions; ability to remain objective and separate facts from opinions. * Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations. * Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. * Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems. * Understanding of datamining and use of data analytics to detect fraud, waste, and abuse. * Proven ability to research and interpret regulatory requirements. * Effective interpersonal skills and customer service focus; ability to interact with individuals at all levels. * Excellent oral and written communication skills; presentation skills with ability to create and deliver training, informational and other types of programs. * Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook), SharePoint and Intra/Internet as well as proficiency with incorporating/merging documents from various applications. * Strong logical, analytical, critical thinking and problem-solving skills. * Initiative, excellent follow-through, persistence in locating and securing needed information. * Fundamental understanding of audits and corrective actions. * Ability to multi-task and operate effectively across geographic and functional boundaries. * Detail-oriented, self-motivated, able to meet tight deadlines. * Ability to develop realistic, motivating goals and objectives, track progress and adapt to changing priorities. * Energetic and forward thinking with high ethical standards and a professional image. * Collaborative and team-oriented REQUIRED LICENSE, CERTIFICATION, ASSOCIATION: * Valid driver's license required. PREFERRED EXPERIENCE: At least 5 years of experience in FWA or related work. PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: * Health Care Anti-Fraud Associate (HCAFA). * Accredited Health Care Fraud Investigator (AHFI). * Certified Fraud Examiner (CFE). To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.82 - $51.06 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.