21 policy analyst jobs found

Become a part of our caring community and help us put health first The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Behavioral Health Professional 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives,...

Become a part of our caring community and help us put health first The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Behavioral Health Professional 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives,...

Location: Anywhere in Country At EY, we're all in to shape your future with confidence. We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world. ServiceNow Senior Consultant - IT Service Management (ITSM) In the digital economy, it takes more than good ideas and strong leadership to thrive. Upgrading outdated processes, systems and information is vital - but can be a risky investment in such a rapidly changing environment. That's why some of the most prestigious businesses worldwide look to us for authoritative, agile, and efficient solutions for business decision-making. As a ServiceNow Senior Consultant you'll play a leading role in that mission, providing the competitive edge our clients need to overcome some of the biggest creative and technical challenges around. The opportunity You'll lead ServiceNow Transformation teams in a rapidly growing...

Location: Anywhere in Country At EY, we're all in to shape your future with confidence. We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world. ServiceNow Senior Consultant - IT Service Management (ITSM) In the digital economy, it takes more than good ideas and strong leadership to thrive. Upgrading outdated processes, systems and information is vital - but can be a risky investment in such a rapidly changing environment. That's why some of the most prestigious businesses worldwide look to us for authoritative, agile, and efficient solutions for business decision-making. As a ServiceNow Senior Consultant you'll play a leading role in that mission, providing the competitive edge our clients need to overcome some of the biggest creative and technical challenges around. The opportunity You'll lead ServiceNow Transformation teams in a rapidly growing...

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Compliance Analyst (Regulatory Change Management) - Remote Job Description The Compliance Analyst assists in the implementation of Prime's compliance programs within their designated areas and partners with key internal stakeholders to monitor aspects of compliance and validate policies, procedures, licensure, and program manuals are effectively followed and maintained. Responsibilities Executes compliance procedures and enforces policy governance across the organization to validate requirements are met and that business operations are aligned with expectations of applicable regulatory guidance Develop solutions to moderately complex compliance problems by referring to precedence, policies and standard...

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title Senior Compliance Analyst (Regulatory Change Management) - Remote Job Description The Senior Compliance Analyst assists in the implementation of Prime's compliance programs and leads initiatives within their designated areas. This role partners with key internal stakeholders to monitor aspects of compliance and validate policies, procedures, licensure, and program manuals are effectively followed and maintained. Responsibilities Executes compliance procedures and enforces policy governance across the organization to validate regulatory reporting requirements are met and that business operations are aligned with expectations of applicable regulatory guidance Lead project management efforts for highly sensitive...

Become a part of our caring community and help us put health first The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors. Earn a $5,000 hiring bonus! Bonus is paid after 180 days of employment; you must be employed until that date to be eligible to receive the payment." Location: Remote - United States Schedule: 8-hour shifts, Monday through Friday, between 10:30 AM and 11:00 PM EST OR 10-hour shifts, Tuesday through Friday, between 10:30 AM and 11:00 PM EST Required to work every 5th Saturday Required to work 1 company holiday...

Healthcare Management Services (HCMS) Director Senior Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if the candidate resides within a commutable distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Healthcare Management Services (HCMS) Director Senior is responsible for the development, implementation, and oversight of integrated Medical Management of more than one member population type of Physical Health and/or Behavioral Health with varying degrees of...

Become a part of our caring community and help us put health first The Project Management Lead manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Project Management Lead designs, communicates, and implements an operational plan for completing the project; monitors progress and performance against the project plan; takes action to resolve operational problems and minimize delays. Identifies, develops, and gathers the resources to complete the project. Prepares designs and work specifications; develops project schedules, budgets and forecasts; and selecting materials, equipment, project staff, and external contractors. Communicates with other operational areas in the organization to secure specialized resources and contributions for the project. Conducts meetings and prepare reports to communicate the...

Director, Product Management: Capital One Shopping (Remote - Eligible) About Capital One Shopping Capital One Shopping is an industry-leading consumer technology business that is changing the way people buy and save online. The team operates with extreme focus to accelerate growth of the Shopping business, find best-in-market savings for shoppers, and create unique value for our merchant partners. Technology and a rapid test-and-learn methodology are applied to nearly all of our business challenges. The team has a flat organizational structure that emphasizes clear ownership, small teams, and leverage through technology. We are looking for a Product Manager to join our team to improve and integrate new product and revenue opportunities with our merchant partners, and drive cross-functional execution within Shopping. Role Description: In this role, you will be a key driver of business growth - owning all aspects of the team, technology, and tooling that onboards and...

Become a part of our caring community and help us put health first Encounter Data Management Professional is responsible for ensuring accurate submission and reconciliation of encounter data to Medicaid and Medicare through effective business processes. Ensures claims submissions meet or exceed all compliance standards via analysis of data and develops tools to enhance the encounter acceptance rate by Medicaid/Medicare. Looks for long-term improvements of claims submission processes. Takes ownership by applying professional standards, regulations, and strategies within their work area. Independently sets priorities and makes decisions on work approach while following established direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Humana's Encounter Data Management (EDM) team is seeking an Encounter Data Management Professional that has experience with business processing and data...

Company : Highmark Health Job Description : JOB SUMMARY The Director of Data Product Management is a leadership role responsible for developing, implementing, and continually refining our customer data product strategy from its foundational stages. This individual will define, develop, and execute the strategy for our core customer data products, ensuring they meet the evolving needs of Highmark and our customers. This individual will lead a team of product managers and analysts focused on specific areas of customer data, driving the realization of our Customer Data Product Strategy vision to empower downstream teams with personalized, high-quality, and timely interactions. This role requires a strong leader who can translate strategic opportunities into actionable product roadmaps, champion data quality and governance, and foster a data-driven culture. A robust technical background and the ability to effectively collaborate with engineering teams are paramount to...

Company : Highmark Health Job Description : JOB SUMMARY This is a hybrid role if you live within a 50 mile radius of one of our office locations in PA, NY or DE This role is responsible for contributing to the product strategy and roadmap for a defined product area, by managing a team while working under the direction of leadership. This role focuses on deeply understanding customer needs, market trends, and competitive landscape to inform product development decisions. The incumbent works cross-functionally to manage a team that is executing a portfolio roadmap or portfolio of product roadmaps and delivering high-quality products that meet business objectives. They will manage the product backlog for a specific product or feature set. ESSENTIAL RESPONSIBILITIES Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance...

Location: Anywhere in Country At EY, we're all in to shape your future with confidence. We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world. ServiceNow Consulting Manager - IT Service Management (ITSM) In the digital economy, it takes more than good ideas and strong leadership to thrive. Upgrading outdated processes, systems and information is vital - but can be a risky investment in such a rapidly changing environment. That's why some of the most prestigious businesses worldwide look to us for authoritative, agile, and efficient solutions for business decision-making. As a ServiceNow Consulting Manager you'll play a leading role in that mission, providing the competitive edge our clients need to overcome some of the biggest creative and technical challenges around. The opportunity You'll lead ServiceNow Transformation teams in a rapidly growing...

Location: Anywhere in Country At EY, we're all in to shape your future with confidence. We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world. ServiceNow Consulting Manager - IT Service Management (ITSM) In the digital economy, it takes more than good ideas and strong leadership to thrive. Upgrading outdated processes, systems and information is vital - but can be a risky investment in such a rapidly changing environment. That's why some of the most prestigious businesses worldwide look to us for authoritative, agile, and efficient solutions for business decision-making. As a ServiceNow Consulting Manager you'll play a leading role in that mission, providing the competitive edge our clients need to overcome some of the biggest creative and technical challenges around. The opportunity You'll lead ServiceNow Transformation teams in a rapidly growing...

Become a part of our caring community and help us put health first Care Manager Support Assistants assist in ensuring TRICARE beneficiaries receive the highest quality health care for Autism Spectrum Disorder (ASD) related services in accordance with the Autism Care Demonstration (ACD). This role supports the Autism Service Navigator (ASN) by verifying eligibility for the ACD and monitoring and supporting the family for 180 to assist with any barriers to accessing services; education and initial registration into ECHO registration portal for active duty family members; assistance with regional transfers and ensuring the receiving Managed Care Support Contractor receives the appropriate paperwork; processes faxes for ECHO eligibility or other paperwork pertaining to ACD requirements such as eligibility, referrals, etc.; and identification of ABA providers and researching necessary resources to support the beneficiary. KEY ACCOUNTABILITIES Assist beneficiaries with...

Location: Anywhere in Country At EY, we're all in to shape your future with confidence. We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world. Manager - Data Management Architect The opportunity We're hiring an experienced Data Management Architect that is an expert in the modern data engineering and data management. The Data Management Architect will design the architecture for data ingestion, data preparation/transformation, data governance, data security, data training and other functions for complex enterprise applications. Deep understanding of structured and unstructured data management in context of AI training and fine tuning. Data formats and storage capabilities with performance considerations in the selection of storage systems and formats. The candidate should thrive in fast-paced environments and are passionate about enabling scalable...

Manager, Product Management - Velocity Black (Remote) This is your opportunity to join Capital One's new, luxury vertical: Velocity Black. Within Capital One, the Velocity Black team is a leading digital concierge company that delivers travel, entertainment, shopping and dining offerings to consumers globally. Velocity Black has built a unique customer experience - its proprietary platform offers inspiration, recommendations and fulfillment in one place, making it an integral part of customers' lives. The Product team reimagines the status quo and drives innovative, sustainable experiences through technology. To be successful in the role, you will need to be a well-rounded 'business athlete' - a creative, analytical, and technically proficient problem solver who understands both the dynamics of the business and the tech landscape. The ideal candidate is resourceful, motivated, and self-sufficient, with demonstrated success in spearheading cross-functional projects that drive...

Location: Anywhere in Country At EY, we're all in to shape your future with confidence. We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world. Manager - Data Management Architect The opportunity We're hiring an experienced Data Management Architect that is an expert in the modern data engineering and data management. The Data Management Architect will design the architecture for data ingestion, data preparation/transformation, data governance, data security, data training and other functions for complex enterprise applications. Deep understanding of structured and unstructured data management in context of AI training and fine tuning. Data formats and storage capabilities with performance considerations in the selection of storage systems and formats. The candidate should thrive in fast-paced environments and are passionate about enabling scalable...

Location: Anywhere in Country At EY, we're all in to shape your future with confidence. We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world. ServiceNow Consulting Manager - Strategic Portfolio Management (SPM) In the digital economy, it takes more than good ideas and strong leadership to thrive. Upgrading outdated processes, systems and information is vital - but can be a risky investment in such a rapidly changing environment. That's why some of the most prestigious businesses worldwide look to us for authoritative, agile, and efficient solutions for business decision-making. As a ServiceNow Consulting Manager you'll play a leading role in that mission, providing the competitive edge our clients need to overcome some of the biggest creative and technical challenges around. The opportunity You'll lead ServiceNow Transformation teams in a...

Become a part of our caring community and help us put health first The Workforce Management Professional 1 applies and integrates advanced and predictive analysis, people metrics and reporting to develop strategic and operational insights for workforce decision-making (e.g., staffing, learning and development, talent management, diversity and human resource compliance). The Workforce Management Professional 1 work assignments are often straightforward and of moderate complexity. The Workforce Management Professional 1 assesses organizational staffing and identifies requirements and solutions to meet workforce objectives. Provides analysis of talent and staffing needs based on strategic planning at the enterprise level. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented...