Emblems Jobs In Remote - 18 Job Positions Available

Audit Coordination Manager Lead and coordinate all phases of external regulatory audits across Medicare Advantage, Medicare Part D, Medicaid Managed Care (including Child Health Plus), and Commercial (on and off exchange) plan products, ensuring timely and

Care Management Nurse Provide care management, as part of a multi-disciplinary care team, that includes care coordination, performing telephonic or face-to-face assessments of members health care needs, identifying gaps in care and needed support, administering/coordinating implementation

Program Management Load all Professional, Facility, and Ancillary contracts across all EmblemHealth lines of business in a timely and accurate manner. Provide subject matter expertise in all areas of contract configuration, fee schedules/groupers, and rate reimbursement.

Pharmacy Benefit Plan Design Specialist Support eligibility and benefits configuration and deployment, including collaboration with pharmacy benefits manager (PBM) and Cognizant, formulary teams, for configuration. Responsible for Quality Assurance and Testing for operations and implementations. Coordinate

Clinical Position at EmblemHealth Perform clinical reviews within the Medical Management Operations Concurrent Review utilization management department. Ensure accurate administration of benefits, execution of clinical policy and timely access to appropriate levels of care. Principal Accountabilities:

Pharmacy Account Management Lead Lead and direct pharmacy account management for the enterprise, including managing and leading Pharmacy Account Manager(s) and Clinical Pharmacy Account Manager(s) for both pharmacy direct clients as well as shared clients with

Sales Manager Law Enforcement & Military Markets Fully Remote | Continental U.S. | Competitive Base + OTE About the Opportunity Our client is a recognized leader in emblem, insignia, patch, and decoration solutions serving law enforcement, military,

Clinical Operations Responsible for the execution of the non-clinical aspects of the Care Management process. Ensure information is appropriately entered in the system to effectively execute member care plans, originate authorizations, request clinical information, perform case

Regulatory Compliance Manager Partner with functional departments/vendors/delegates to ensure they are in full compliance with all actionable and informational regulatory notices. Identify new and revised regulatory guidance; create paths of communication to business units. Ensure that

Care Management Nurse Provide care management, as part of a multi-disciplinary care team, that includes care coordination, performing telephonic or face-to-face assessments of members health care needs, identifying gaps in care and needed support, administering/coordinating implementation

Product Management Enable better, faster, and more confident decisions by translating complex financial, clinical, and operational data into clear insights that inform strategy, product choices, and performance management for all Commercial Business to Business lines of