Medicare jobs in Reston, VA

Remote

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13d ago

Immediate need for a talented Medicare Benefits Advisor. This is a 03 - 04+months contract opportunity with long-term potential and is located in Denver, CO (Remote). Please review the job description below and contact me ASAP if you are interested. Job ID: 26-22375 Pay Range: $37/hr - $40/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: Work Schedule & HoursPa

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Contract

$37 - $40

Automation Mobile Tester with Medicare

Remote or Hybrid

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2d ago

Remote position Must have Medicare exp & Mobile testing Must Have: 5+ years of Medicare experience 10 + years of experience in technology Quality Engineering. Strong experience with UI and Mobile OS (iOS/Android) testing Proficiency in API testing tools such as Postman, Bruno, or REST Assured. Experience of SDLC processes, agile methodology and QE practices. Agile certification is preferred. Experience with using AWS services like S3, Lambda, DynamoDb etc. Strong experience with UI and database

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Third Party

Enterprise Data Modeler Medicare Advantage

Remote

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5d ago

We are looking for a Senior Enterprise Data Modeler with deep healthcare domain expertise to lead the development of enterprise and domain data models for a strategic data transformation program. You will bridge the gap between business stakeholders and technical execution teams to build resilient, enterprise-wide data structures. Key ResponsibilitiesDesign and maintain Enterprise, Logical, Physical, and Canonical Data Models. Translate complex business concepts into robust domain data models. P

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Contract

Depends on Experience

Clinical Pharmacist Advisor - Medicare - Remote

Remote

•

24d ago

Title: Clinical Pharmacist Advisor - Medicare - Remote Mandatory skills: managed care, PBM environment, institutional healthcare, pharmacy, Case Review, Processing, incoming coverage-related requests, Accurately set up cases, review documentation, apply work instructions, business, medical correspondence, technical procedures, Medicare regulations, Outreach, Information Gathering, Conduct outbound calls, positive business image, Documentation, Accuracy, Compliance Standards, CMS-mandated timelin

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Contract

47 - 52

Data Modeler with Medicare Advantage

Remote

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11d ago

Enterprise Data Modeler (Medicare Advantage) Position Summary We are seeking a highly experiencedEnterprise Data Modelerto lead the development of enterprise and domain data models that will serve as the foundation of a strategic enterprise data transformation program. This role will be responsible for creating and maintaining: Enterprise Business Data ModelsCanonical Data ModelsLogical Data ModelsPhysical Data ModelsDomain Data Models across prioritized business domainsCritical Success Factors

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Contract

Depends on Experience

Healthcare Informatics Analyst (Pharmacy OR Medicare Advantage - Fully Remote Contract Role )

Remote

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23d ago

Position 2: Sr. Healthcare Informatics Analyst (Medicare Advantage)Seeking a Senior Healthcare Informatics Analyst! The selected candidate will independently provide analytics in understanding and improving how health care is valued, utilized and provided. This position will develop analytic attributes that pertain to patient level health utilization/outcome, provider performance measures, risk-adjusted revenue optimization, medical cost management, and behavior attributes on patient/provider en

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Contract

75 - 80

Functional Business Analyst with SNAP, TANF, QHP, Medicaid/Medicare programs exp - 100% Remote - W2

Remote

•

10d ago

WHO WE ARE: Founded in 2007, DTI (Diversified Technology, Inc.) is a successful African American owned IT Consulting/Staffing firm based in Chicago''s Loop. WHAT WE DO: We focus on providing delivery, staffing, and supported services such as enterprise integration/implementations including, but not limited to, CRM, EAM, ERP, PMO, and QA. We service clients in SLED (state/local gov''t & education), financial services, fortune, public utility, as well as regularly partnering with Big 4 SI partner

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Contract

40 - 40

Project Manager with OCM

McLean, Virginia

•

Today

JOB TITLE: Project Manager with OCM JOB LOCATION: Remote WAGE RANGE*: 80 - 85/ hour JOB NUMBER: 000010 REQUIRED EXPERIENCE: Qualifications & Requirements Education: Bachelor's degree in Business Administration, Healthcare Management, or a related domain. PM Experience: 5 to 7+ years of rigorous project management experience utilizing formal project management structures (PMP certification heavily preferred). OCM Experience: Minimum 3 consecutive years of full-time dedication to managing o

Full-time

USD 80.00 - 85.00 per hour

Project Manager with CMS Fee-For-Service Data Collection System (FFSDCS)

Washington, District of Columbia

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11d ago

Project Manager CMS Fee-For-Service Data Collection System (FFSDCS) Position Summary We are seeking an experienced Project Manager to lead delivery of the CMS Fee-ForService Data Collection System (FFSDCS) a Medicare data collection platform used by drug manufacturers, clinical laboratories, hospitals, and ground ambulance providers to meet their federal reporting requirements. You will own delivery end to end scope, schedule, budget, quality, and staffing for an Agile team supporting four

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Contract

Depends on Experience

Full Stack Engineer (Node/React) - Remote USA

Remote or Reston, Virginia

•

Today

The Team Our Health Engineering Solutions (HES) team works side by side with customers to articulate a vision for success, and then make it happen. We know success doesn't happen by accident. It takes the right team of people, working together on the right solutions for the customer. We are looking for a seasoned Full Stack Engineer who will be a key driver to make this happen. Our team supports the vision to improve patient quality care and consumer decision-making by hospital providers across

Full-time

USD 98,614.00 - 167,644.00 per year

Product Owner – Capitation & Value-Based Care

Remote

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20d ago

Job Title: Product Owner Capitation & Value-Based Care Location: Remote/Hybrid Experience: 712 Years Position Summary We are looking for a Product Owner with deep experience in Capitation, Value-Based Care (VBC), and Provider Reimbursement. This role will own products supporting capitation payments, provider incentives, attribution, quality programs, and population health analytics while partnering with payer and provider stakeholders. Capitation is a payment model where providers receive a fix

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Contract

Depends on Experience

HRSN Medicaid Claims Analyst With QNXT

Remote

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5d ago

Position- HRSN Medicaid Claims Analyst Type- 100% Remote (PST Hours) Visa- No H1 What you'll do: Review and resolve HRSN claims assigned through QNXT work queues including rent, rental arrears, utility assistance, storage, and housing support claims. You'll analyze pended, denied, and audit-flagged claims, correct claim data, resolve QNXT edits, review potential duplicate submissions, and move valid claims through adjudication and payment. Much of the initial work focuses on reducing the existin

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Third Party, Contract

Depends on Experience

Claims Examiner - Workers Compensation - W2 Only

Remote

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4d ago

Position: Claims Examiner - Workers Compensation - W2 Only Duration: 03 Months of Contract with possible extension or conversion Pay Range: $52/hr to $56/hr on W2 (without Benefits) Requirements: Only Ex-Sedgwick candidatesAny specific skill/ certification/ license: CA adjuster certificationYears of experience: 3+ years of relevant experience Primary purpose: To analyze complex or technically difficult workers'' compensation claims to determine benefits due; to work with high exposure claims

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Contract

52 - 56

Technical Project/Delivery Manager With Medicaid Experience - Remote

Remote

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2d ago

Required:15+ years of overall IT experience5+ years of managerial experienceDeep functional knowledge of Healthcare processes specially Medicaid BusinessAware of the Cloud native architecture along with understanding of associated technologiesDemonstrated understanding of Project Management processes, strategies and methodsExperience mentoring, coaching and developing rising talent in the technology departmentExcellent time management and organizational skills and experience establishing guideli

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Contract, Third Party

$61

Epic Tapestry Contracts Administration SME

Remote

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19d ago

** This is 5 months contract with possibility of extension. Work Arrangement: 100% Remote Schedule: Full-time, 40 hours per week Working Hours: Eastern Time business hours Industry: Healthcare Insurance / Health Plan Position SummaryWe are seeking an experienced Epic Tapestry Contracts Administration Subject Matter Expert to lead contract-related application build and provide structured knowledge transfer within a healthcare insurance environment. This is a hands-on SME-level position requiring

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Contract, Third Party

Depends on Experience

Business Analyst III

Remote

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4d ago

Immediate need for a talented Business Analyst . This is a 10+ months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested. Job ID:26-25605 Pay Range: $35/hr - $40/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: Schedule: MondayFriday, 8:00 AM5:00 PM EST o

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Contract

35 - 40

Applied Behavior Analysis / ABA (Utilization Management)

Remote

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5d ago

Active BCBA (Board Certified Behavior Analyst) certification and state licensure (3+ years of ABA (Applied Behavior Analysis) clinical experience - Required Experience creating and supervising ABA (Applied Behavior Analysis) treatment plans Direct patient care background (dealing with children with Behavior / Autism issues) Utilization Management or insurance review experience strongly preferred Comfortable reviewing medical necessity and authorization requests Familiar with managed care and pay

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Contract

Depends on Experience

Product Owner – Healthcare PDM / PLM / Capitation

Remote

•

5d ago

Product Owner Healthcare PDM / PLM / Capitation Location: Remote USA Job Type: Contract W2 Experience: 5+ Years Domain: Healthcare Payer / Health Plan / Managed Care Job Summary Seeking an experienced Product Owner with strong expertise in Provider Data Management (PDM), Provider Lifecycle Management (PLM), and Healthcare Capitation to lead Agile product initiatives. Key Responsibilities Own and prioritize product backlogs for PDM, PLM, and Healthcare Capitation.Define Epics, User Stories, Acc

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Contract

Depends on Experience

Epic Tapestry Utilization Management Analyst

Remote

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19d ago

This is 3 months contract with possibility of extention. You can work part time as well (20 hours/week)Position SummaryWe are seeking an experienced Epic Tapestry Utilization Management Analyst to support the design, configuration, build, testing, and implementation of Appeals and Grievances workflows within a healthcare insurance environment. The consultant will work closely with utilization management, appeals and grievances operations, compliance, business, and technical stakeholders to trans

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Third Party, Contract

Depends on Experience

ICF Incorporated, LLC: Senior Software Engineer (Multiple Positions) Reston, VA.

Reston, Virginia

•

Today

ICF Incorporated, LLC: Senior Software Engineer (Multiple Positions) Reston, VA. DUTIES: Apply computer science, software engineering, databases, and distributed/parallel processing frameworks to prepare big data for the use of scoring and scoring results.Work on projects that support the Centers for Medicare and Medicaid Services (CMS) as we develop and support the collection of data and scoring results associated with clinicians.Use Spark to build data processing pipelines that derive informa

Full-time

USD 175,427.00 - 183,610.00 per year

Medicare jobs in Reston, VA, USA