28 ltc claims operations manager jobs found

Summary The LTC Charles S. Kettles VA Medical Center is recruiting to fill a Medical Supply Technician (Sterile Processing) position. The Medical Supply Technician (MST) will function in Sterile Processing Service. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Federal employees - Excepted service Current federal employees whose agencies have their own hiring rules, pay scales and evaluation criteria. Clarification from the agency This position is open to current, permanent VA employees, other current permanent Federal agency employees and the public. First area of consideration are Current, permanent LTC Charles S Kettles VA Medical Center and CBOC employees. Veterans' preference does not apply. NOTE: The 2-page Resume requirement does not apply to this occupational series. For more information, refer to Required Documents below. Duties Total Rewards of a Allied Health...

Become a part of our caring community and help us put health first The Director, Payment Integrity uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. The Director leverages technology and the clinical and coding expertise of their associates to identify potential overpayments to be substantiated via review of medical records. The Director contributes to the investigations of fraud, waste and abuse. The Director requires an in-depth understanding of how organizational capabilities interrelate across the function or segment. The Clinical and Coding Medical Record Review Director of Payment Integrity contributes to overall cost reduction, by increasing the accuracy of provider payments in our payer systems, and by ensuring correct claims payment. The Director contributes to overall cost reduction, by increasing the accuracy of provider payments via a complex array of medical record audit programs performed by coders and...

The Retail Service Specialist will support the Store Manager and Assistant Managers in areas of sales, customer service, store appearance, and store operations. This position will also assume shift management responsibilities in the absence of Assistant or Store Manager. Bilingual candidates encouraged to apply. ESSENTIAL JOB FUNCTIONS Lead store team members in providing excellent customer service to retail and professional customers. Supervise the customer service levels on the retail showroom to include team member execution on customer service programs (Related sales, Hi5, Rock the Call, Never Say No, Rock the Lot, etc…) Ensure telephone is answered according to company policy. Ensure all buy online/ship to store, hub and store to store transfers, and DC add orders are processed in a timely manner and customers are contacted upon shipment arrivals as needed. Ensure special orders and outside purchases are handled efficiently and according to procedure,...

The Retail Service Specialist will support the Store Manager and Assistant Managers in areas of sales, customer service, store appearance, and store operations. This position will also assume shift management responsibilities in the absence of Assistant or Store Manager. Bilingual candidates encouraged to apply. ESSENTIAL JOB FUNCTIONS Lead store team members in providing excellent customer service to retail and professional customers. Supervise the customer service levels on the retail showroom to include team member execution on customer service programs (Related sales, Hi5, Rock the Call, Never Say No, Rock the Lot, etc…) Ensure telephone is answered according to company policy. Ensure all buy online/ship to store, hub and store to store transfers, and DC add orders are processed in a timely manner and customers are contacted upon shipment arrivals as needed. Ensure special orders and outside purchases are handled efficiently and according to procedure,...

As an EHS Manager, you aren't just a compliance officer; you are the strategic guardian of our most valuable asset: our people. You will lead the charge in fostering a "Safety First" culture, balancing technical expertise with empathetic leadership. You’ll oversee the EHS department, mentor a team of coordinators and interns, and serve as the subject matter expert for all health, safety, and environmental initiatives across the site. This is a full-time, permanent opportunity to join a global automotive company, where your authority and SME knowledge is respected, and your contribution directly impacts the well-being of hundreds of colleagues. Read on to learn more - and apply today to be considered. salary: $125,000 - $135,000 per year shift: First work hours: 7 AM - 4 PM education: Bachelors Responsibilities Strategic Leadership & Culture Culture Champion: Drive the Group HSE policy, transforming compliance into a lived culture of safety and stewardship....

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 Sr. IT Systems Analyst (Data Analyst) Remote Job Description As a Senior IT Systems Analyst (Data Analyst) , you will play a key role in managing and optimizing system and data integrations that support Prime's clinical vendor hub, PartnerIQ . In this role, you will serve as a technical and analytical subject-matter expert responsible for driving seamless data flow between internal platforms, external vendors, and client partners. You will lead end-to-end integration processes including intake, requirements gathering, source-to-target (STT) mapping, SFTP configuration, environment and data readiness, testing, and ongoing IT service management . This position will support and enhance Prime's internal data pipelines...

The Director, Medical Excellence & Operations (ME&O) Insights & Analytics will lead the development and execution of a global strategy for integrating and leveraging data-driven insights across multiple Global Medical Affairs (GMA) functions. This role will be responsible for managing the Manager, Medical Analytics and is pivotal in shaping how GMA uses analytics to optimize performance, enhance decision-making, and deliver measurable impact across therapeutic areas. The Director, Medical Excellence & Operations (ME&O) Insights & Analytics will report to the Senior Director, Medical Affairs Solutions & Analytics and will leverage strategic vision, operational excellence, and expertise in data integration to drive innovation and efficiency across functions such as Medical Information, Field Medical, Medical Strategy, and Medical Education. Preferred therapeutic experience includes Nephrology, Central Nervous System (CNS), and rare disease. Key...

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 Sr. IT Systems Analyst (Data Analyst) Remote Job Description As a Senior IT Systems Analyst (Data Analyst) , you will play a key role in managing and optimizing system and data integrations that support Prime's clinical vendor hub, PartnerIQ . In this role, you will serve as a technical and analytical subject-matter expert responsible for driving seamless data flow between internal platforms, external vendors, and client partners. You will lead end-to-end integration processes including intake, requirements gathering, source-to-target (STT) mapping, SFTP configuration, environment and data readiness, testing, and ongoing IT service management . This position will support and enhance Prime's internal data pipelines...

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 Sr Health Informatics Analyst - Remote Job Description The Sr. Health Informatics Analyst leads advanced data initiatives that support clinical programs, cost containment strategies, and operational effectiveness. This role partners with cross-functional teams, including clinical services, pharmacy operations, product management, and client services, to transform complex healthcare data into actionable insights. The position applies advanced statistical, analytic, and business acumen, and champions evidence-based decision-making, regulatory compliance, and improved patient and business outcomes. Responsibilities Analyze large-scale healthcare claims, eligibility, provider, and clinical data to identify trends,...

Sumitomo Pharma Co., Ltd., is a global pharmaceutical company based in Japan with operations in the U.S. (Sumitomo Pharma America, Inc.), focused on addressing patient needs in oncology, urology, women's health, rare diseases, cell & gene therapies and CNS. With several marketed products and a diverse pipeline of early- to late-stage investigational assets, we aim to accelerate discovery, research, and development to bring novel therapies to patients sooner. For more information on SMPA, visit our website https://www.us.sumitomo-pharma.com or follow us on LinkedIn. Job Overview The LTC Account Manager delivers results by strategically educating key LTC stakeholders including closed door pharmacies, consultant pharmacists, and Tier 1 Nursing Home chains in a compliant and ethical manner, while collaborating with the sales team on educating LTC Healthcare Providers on SMPA product clinical attributes for the LTC resident. They ensure customer satisfaction by understanding...

Summary This position serves as Health System Specialist - Research Committee Manager within the Research and Development (R&D) Service. The VA Research Program strives to promote Veteran-centered care to improve patient experiences and outcomes across VA healthcare and community settings, and to advance value-driven care by providing Veterans the highest quality care at the lowest financial burden. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Duties ** *THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION*** The major duties include but are not limited to: Research and Development (R&D), Institutional Review Board (IRB), Institutional Animal Care and Use Committees (IACUC), Subcommittee for Research Safety (SRS), Central Institutional Review Board (CIRB), Institutional Biosafety Committee (IBC),...

The DI Underwriting Medical Consultant , reporting to the Manager, Underwriting Policy and Support in the Underwriting Policy area, is a key business partner for DI Underwriting. This position assists in maintaining the DI underwriting guidelines and is responsible for reviewing individual health risk characteristics for complicated applicants, assisting in making recommendations to underwriting. The role combines clinical judgment, analytics, and strong communication. The applicant should be a medical professional who can understand health conditions and personal characteristics, singly and in combination, and how they influence the probability of disability. You will Assist with medical reviews of current underwriting cases Review older underwriting and claims files when needed to support ongoing IDI underwriting policy research projects Medical guideline authorship, drafting, updating and driving change across underwriting Review medical literature...

Position Summary Serves as the key stakeholder and subject matter expert (SME) representing Medical review function in internal audits, and health authority inspections. Being available on-site for inspections, internal audit and critical business activities, including at short notice. Provides oversight of the safety profile of Otsuka products Leads the development and execution of medical review strategies for investigational and marketed products Provides strategic leadership of the Global Medical review function and collaborates with other PV functions, vendors and partners. Serves as a member of the Global Medical Safety (GMS) Leadership Team partnering closely with the GMS Head Meets routinely with product specific GPV team members and acts as principal liaison for medical review matters to engage with regulatory agencies on product safety issues. Key Job Responsibilities Represents GPV Medical Safety department from a...

Summary This incumbent is under the direct supervision of the Chief, Health Information Management(HIMs). Medical Records Administration Specialist (MRAS) in VHA perform work concerned with the management of a health record program or the provision of services related to medical record administration/health information services. *Position updated to remove bargaining unit status* This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Veterans Veterans of the U.S. Armed Forces or a spouse, widow, widower or parent of a veteran, who may be eligible for derived preference Clarification from the agency NOTE: The 2-page Resume requirement does not apply to this position. For more information, refer to Required Documents below. ****** Only the first 50 applicants will be considered for this position. *********** Duties The Medical Records Administration Specialist (MRAS) works...

Summary The Lead Registered Respiratory Therapist is under the technical and administrative supervision of the Chief Respiratory Therapist in the Respiratory Care Services, the Medical Direction of the Chief of the Pulmonary Section, and the administrative supervision of the Chief Medical Services. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Federal employees - Competitive service Current federal employees whose agencies follow the U.S. Office of Personnel Management's hiring rules and pay scales. Federal employees - Excepted service Current federal employees whose agencies have their own hiring rules, pay scales and evaluation criteria. Internal to an agency Current federal employees of the hiring agency that posted the job announcement. Clarification from the agency NOTE: The 2-page Resume requirement does not apply to this position. For more information, refer...

Summary This position serves as Supply Technician (Medical) for the Medical Supply Distribution (MSD) areas of Logistics Service located at the Veteran Healthcare System in Battle Creek, MI. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Duties ** *THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION*** As a Supply Technician, you will provide wards, clinics, operating rooms, secondary storage locations, and other hospital facilities with supplies and material including, but not limited to, sterile and non-sterile medical supplies, instrument sets and equipment. Major duties and responsibilities include: Pulls stock inventory and material for delivery; replenishes stock inventory; interacts with clinical and administrative customers and maintains records on stock levels; Communicates to the Lead or Supervisor...

Summary Corrections professionals who foster a humane and secure environment and ensure public safety by preparing individuals for successful reentry into our communities. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Clarification from the agency • THIS IS A DELEGATED EXAMINING ANNOUNCEMENT OPEN TO ALL U.S. CITIZENS. • Duty Location: FCI Milan, MI Duties This position is located in the Federal Prison Industries, UNICOR Factory, Federal Correctional Institution (FCI), Milan, Michigan. Provides employment and training for inmates in designing, building and repairing of tools, dies and fixtures for stamping and assembling metal products. Involved with the manufacturing, repairing, and rebuilding of metal stamping dies, metal piercing details, and items of equipment from raw stock of different metals and metal alloys such as stainless steel alloys, aluminum titanium, magnesium and...

Why Choose Us? Novolex is a leading manufacturer of food, beverage, and specialty packaging that supports multiple industries including foodservice, restaurant delivery and carryout, food processing, grocery and retail, and industrial sectors. Novolex manufacturing and sourcing expertise spans a diverse range of substrates including resin, paper, molded fiber, aluminum and more. We provide customers a broad array of stock and customized solutions with 120 product categories, 250 brands and over 39,000 SKUs. Our Sustainability Commitment The Novolex sustainability vision is built upon three pillars: our products, our operations and our people. Each is critically important to our growth and future as a business. These pillars form the foundation of our company-wide commitment to sustainability, helping us achieve our ambitious goals through our wide-ranging initiatives. Job Description NOW HIRING Maintenance Tech at our Manchester Road location in Kalamazoo, MI! Pay:...

The Assistant Store Manager will support the Store Manager in areas of sales, customer service, store appearance and store operations. This position will manage the store during the Store Manager’s absence and/or when working opposing shifts. The Assistant Manager will be expected to lead the store team members in servicing customers. Bilingual candidates encouraged to apply. ESSENTIAL JOB FUNCTIONS Lead the store team members in providing excellent customer service to retail and professional customers. Supervise the customer service levels on the retail showroom to include team member execution on customer service programs (Related sales, Hi5, Rock the Call, Never Say No, Rock the Lot, etc…) Work with the store manager to ensure the retail sales counter is adequately staffed, especially during peak retail business hours (lunch, late- afternoons, evenings, weekends, etc.) Assist the store manager in setting team member goals, providing feedback on goal...

Position Summary We are seeking a dynamic and experienced Associate Director to lead operations for the relevant therapeutic area Patient Access team, focusing on enhancing patient experience and optimizing support programs. This role will support strategic initiatives, manage across cross-functional teams, and ensure the delivery of innovative patient-centric solutions. This role reports to the Senior Director, Patient Access and serves as the primary day-to-day operational lead for Patient Access programs. The position will work in close partnership with the Director, Market Access Operations, and the Director, Field Reimbursement to ensure seamless execution of access strategies. The individual will act as a key operational advisor and collaborator to drive program excellence. Key Responsibilities The position provides operational and tactical support for the relevant therapeutic area Patient Access team and leads projects collaborating with various cross-functional...

Summary This position is located at the VA Ann Arbor Healthcare System, in Ann Arbor Michigan and involves the application of engineering and science theories, principles and practical concepts to understand and solve environmental problems as part of the Green Environmental Management System. This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Duties ** *THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION*** Duties include but may not be limited to: Supports the development of facility environmental policies, programs, and procedural documentation. Interacts with federal, state, and local environmental agencies with respect to facility environmental issues regarding compliance. Leads environmental audits and incident investigations, conducts root cause analysis, develops corrective actions, and tracks...

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 Supv, Operations - Remote Job Description The Supervisor Operations is responsible for ensuring their team delivers on daily production goals and support of key product offerings (Benefit/Network/FormularyDesign, e-Prescribe, Claims Processing, Integrated Product Solutions, Consumer Directed Health Plan, Medicaid and Medicare plans). This position is responsible for talent management efforts, maintenance of processes and procedures, and providing subject matter expertise for escalated issues or project support. Responsibilities Monitor and manage team workload and capacity, quality metrics, cost, and efficiency to ensure performance guarantees, turnaround times and other internal and external service levels are met...

The Assistant Store Manager will support the Store Manager in areas of sales, customer service, store appearance and store operations. This position will manage the store during the Store Manager’s absence and/or when working opposing shifts. The Assistant Manager will be expected to lead the store team members in servicing customers. Bilingual candidates encouraged to apply. ESSENTIAL JOB FUNCTIONS Lead the store team members in providing excellent customer service to retail and professional customers. Supervise the customer service levels on the retail showroom to include team member execution on customer service programs (Related sales, Hi5, Rock the Call, Never Say No, Rock the Lot, etc…) Work with the store manager to ensure the retail sales counter is adequately staffed, especially during peak retail business hours (lunch, late- afternoons, evenings, weekends, etc.) Assist the store manager in setting team member goals, providing feedback on goal...

The Card Operations team is responsible for all aspects of the UMB card programs. This includes customer loyalty programs, card fraud claims processing, card plastics design and inventory, collateral, card product and program set-up, card network relationships, etc. We are also responsible for ensuring the TSYS TS2 system is configured appropriately to support credit and debit card programs for UMB Consumer, Commercial and Healthcare lines of business. TSYS TS2 platform configuration includes option maintenance requests, service requests, project requests, UATV and production testing, research and remediation. Card Operations also supports TSYS issue management and cardholder complaints. As the Card Operations Specialist, you will be responsible for supporting UMB Card Operations with responsibility for completing operational duties as assigned to ensure smooth and efficient execution of card support services. A primary responsibility of this role will be supporting the...