Excellus BCBS

Job Description: Summary:Conducts case management program activities in accordance with departmental corporate NYS Department of Health (DOH) Centers for Medicaid & Medicare Services (CMS) Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation

Job Description: Summary:Conducts case management program activities in accordance with departmental corporate NYS Department of Health (DOH) Centers for Medicaid & Medicare Services (CMS) Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation

Job Description: Summary:The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical documentation and/or inpatient coding and has a high level of understanding of the current MS-DRG and APR-DRG payment systems.

Job Description: Summary:The Payment Integrity DRG Coding & Clinical Validation Analyst position has an extensive background in acute facility-based clinical documentation and/or inpatient coding and has a high level of understanding of the current MS-DRG and APR-DRG payment systems.

Job Description: Summary:This position is responsible for and participates in a wide range of provider patient and employer initiatives and programs. The pharmacist supports all of our lines of business which include Medicare Commercial Exchange (Marketplace) and Medicaid. The focus o

Job Description: Summary:This position is responsible for and participates in a wide range of provider patient and employer initiatives and programs. The pharmacist supports all of our lines of business which include Medicare Commercial Exchange (Marketplace) and Medicaid. The focus o

Job Description: Summary:The Manager Applications Development is responsible for overseeing and evaluating the work of IT staff in both the development of new applications as well as updates fixes and revisions to existing production systems. Key responsibilities include developing an

Job Description: Summary:The Manager Applications Development is responsible for overseeing and evaluating the work of IT staff in both the development of new applications as well as updates fixes and revisions to existing production systems. Key responsibilities include developing an

Job Description: Summary:This position provides support and often leads initiatives related to the Divisional Strategy and Operations. The incumbent leads various projects and workstreams to ensure effective division performance and consultation on opportunities to improve overall div

Job Description: Summary:This position provides support and often leads initiatives related to the Divisional Strategy and Operations. The incumbent leads various projects and workstreams to ensure effective division performance and consultation on opportunities to improve overall div

Job Description: Summary:This position will partner with both the business area and the technical teams to develop high quality deliverables across all phases of a project and/or complex process implementation from identifying and defining process flows and use cases through to user a

Job Description: Summary:This position will partner with both the business area and the technical teams to develop high quality deliverables across all phases of a project and/or complex process implementation from identifying and defining process flows and use cases through to user a

Job Description: Summary:This role leads the strategic vision roadmap and execution of the Candesa UM product driving innovation and ensuring strong alignment with organizational goals. As a crossfunctional connector the position partners closely with teams across the organization to

Job Description: Summary:This role leads the strategic vision roadmap and execution of the Candesa UM product driving innovation and ensuring strong alignment with organizational goals. As a crossfunctional connector the position partners closely with teams across the organization to

Job Description: Summary:The BI Administrator is responsible for designing developing implementing securing and maintaining Business Intelligence (BI) software environments that drive analytical and data driven decision making across the organization. The BI Administrator works closel

Job Description: Summary:The BI Administrator is responsible for designing developing implementing securing and maintaining Business Intelligence (BI) software environments that drive analytical and data driven decision making across the organization. The BI Administrator works closel

Job Description: Summary:The Cyber Incident Response (IR) Engineer role is critical in detecting investigating and responding to cybersecurity threats across the enterprise. This role supports and leads security operations through proactive threat hunting tool development forensics an

Job Description: Summary:The Cyber Incident Response (IR) Engineer role is critical in detecting investigating and responding to cybersecurity threats across the enterprise. This role supports and leads security operations through proactive threat hunting tool development forensics an

Job Description: Summary:The Network Strategy Planning & Delivery Lead manages crossdivisional strategic initiatives costsaving programs and enterprise planning efforts while ensuring strong coordination with senior leaders and key stakeholders across the organization. This role will

Job Description: Summary:The Network Strategy Planning & Delivery Lead manages crossdivisional strategic initiatives costsaving programs and enterprise planning efforts while ensuring strong coordination with senior leaders and key stakeholders across the organization. This role will

Job Description: Summary:The Reimbursement Plan Administrator responds to and resolves written telephone and personal inquiries from subscribers groups and providers concerning all departmental products policies and procedures in a professional and efficient manner. This position coor

Job Description: Summary:The Reimbursement Plan Administrator responds to and resolves written telephone and personal inquiries from subscribers groups and providers concerning all departmental products policies and procedures in a professional and efficient manner. This position coor

Job Description: Summary:Under the general direction of the Assigned Management and in accordance with sound and ethical procedures objectives and controls a Network Services Analyst analyzes and evaluates the composition and characteristics of Health Plan provider networks. This posi

Job Description: Summary:Under the general direction of the Assigned Management and in accordance with sound and ethical procedures objectives and controls a Network Services Analyst analyzes and evaluates the composition and characteristics of Health Plan provider networks. This posi

Job Description: Summary:Conducts case management program activities in accordance with departmental corporate NYS Department of Health (DOH) Centers for Medicaid & Medicare Services (CMS) Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation

Job Description: Summary:Conducts case management program activities in accordance with departmental corporate NYS Department of Health (DOH) Centers for Medicaid & Medicare Services (CMS) Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation

Job Description: Summary:This position assists the Health Plan in establishing a presence in the community through home visits and community outreach bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about ac

Job Description: Summary:This position assists the Health Plan in establishing a presence in the community through home visits and community outreach bridging the gap between members and the Clinical Operations Department. Community Connections Representatives educate members about ac

Job Description: Summary:The position is responsible for collaborating with leaders across a 2000 person organization to support strategy around how to drive organizational effectiveness through collaboration sharing best practices ensuring effective change management productivity and

Job Description: Summary:The position is responsible for collaborating with leaders across a 2000 person organization to support strategy around how to drive organizational effectiveness through collaboration sharing best practices ensuring effective change management productivity and

Job Description: Summary:The Document Solutions team focuses on the design and creation of correspondence and transactional statements using various software programs. The Publishing Systems Engineer operates in a business analyst/document-generation specialist role as part of the Doc

Job Description: Summary:The Document Solutions team focuses on the design and creation of correspondence and transactional statements using various software programs. The Publishing Systems Engineer operates in a business analyst/document-generation specialist role as part of the Doc

Job Description: Summary:The Manager of Actuarial Services is responsible for managing a team that preforms financial projections and actuarial analyses for complex projects in support of our organizations diverse product portfolio. This role will oversee the development of actuarial

Job Description: Summary:The Manager of Actuarial Services is responsible for managing a team that preforms financial projections and actuarial analyses for complex projects in support of our organizations diverse product portfolio. This role will oversee the development of actuarial

Job Description: This position is onsite/in-person at our Court St. office in Rochester NY.Multiple Overnight Openings Available! Schedule 1: Mon Thurs: 10PM 6:30AM & Fri: 11:55PM - 8:30AM Schedule 2: Sun-Thurs : 10PM - 6:30AM *New hires will temporarily orient on days to start. Sum

Job Description: This position is onsite/in-person at our Court St. office in Rochester NY.Multiple Overnight Openings Available! Schedule 1: Mon Thurs: 10PM 6:30AM & Fri: 11:55PM - 8:30AM Schedule 2: Sun-Thurs : 10PM - 6:30AM *New hires will temporarily orient on days to start. Sum

Job Description: Summary:This position drafts and reviews provider contract documents provides assistance and responds to internal and external inquiries of pertinent regulatory and provider contracting issues.Essential Accountabilities:Works with Corporate Counsel and others in Legal

Job Description: Summary:This position drafts and reviews provider contract documents provides assistance and responds to internal and external inquiries of pertinent regulatory and provider contracting issues.Essential Accountabilities:Works with Corporate Counsel and others in Legal

Job Description: Summary:The Digital Content Developer supports the Health Plans digital initiatives/lifecycle management work and business goals by creating best-in-class digital user experiences for our customers. This role is responsible for the accuracy relevance and timeliness of

Job Description: Summary:The Digital Content Developer supports the Health Plans digital initiatives/lifecycle management work and business goals by creating best-in-class digital user experiences for our customers. This role is responsible for the accuracy relevance and timeliness of