NewSupervisor Registered Nurse Clinic - Administration CHRISTUS HealthSupervisor Registered Nurse Clinic - AdministrationAlamogordo, NMResponsible in assisting the Director for analyzing, planning, implementing, evaluating, and communicating processes and programs which enhance, strengthen and integrate the services comprising the nursing department. The Supervisor collaborates with other clinical and ancillary departments to meet organizational and department-specific Quality and Safety Measures, Community Values, Business Literacy, and Service Excellence goals.
NewImaging Systems Administrator - Radiology Administration CHRISTUS HealthImaging Systems Administrator - Radiology AdministrationSanta Fe, NMAdministers and supports various radiology PACS, and cardiology PACS (Sectra, Lumedx, Merge Cardio, Philips ISCV) as well as advanced imaging applications, interfaces, and storage architecture(s) and related technologies (e.g., voice recognition). Provides support for hemodynamic systems (Merge Hemo, Philips XPer, GE Maclab) and electrophysiology mapping applications (Boston Scientific Rhythmia, Biosense Webster Carto 3).
Director of Healthcare Services FALCON HEALTHCAREDirector of Healthcare ServicesHobbs, NMLicense / Certification: Current State RN license; additional certifications in hospice and palliative care preferred; current CPR; current driver’s license and proof of auto liability. Recruit, train, and supervise a multidisciplinary team of healthcare professionals including nurses, social workers, chaplains, and other support staff.
Professor of Practice-School of Public Administration University of New MexicoProfessor of Practice-School of Public AdministrationAlbuquerque, NMIn addition, the faculty member will be responsible for facilitating the practicum requirement (PADM 655), including developing and maintaining relationships with partner organizations and preceptors, overseeing student practicum experiences, and managing the practicum waiver petition process. The faculty member will also contribute, as appropriate, to the Performance Academy in support of workforce development and training goals for the State of New Mexico.
Lead, Medicare Administration (Bids & Member Materials) (Remote) Molina Healthcare IncLead, Medicare Administration (Bids & Member Materials) (Remote)NMRemoteWorks collaboratively with business and operational units to ensure Medicare and MMP operations are supported by effective, accurate and efficient business processes, benefits are accurately defined, communicated and configured, member communications are compliant, and data exchanges and reports are accurate, timely and meet federal requirements. Job Summary Provides lead level support for Medicare and Medicare-Medicaid Plan (MMP) Duals products including the development, implementation, and maintenance of annual project timelines/work plans for both product lines - ensuring timely and successful project completion.
Healthcare Recruiter Maxim Healthcare Services IncHealthcare RecruiterAlbuquerque, NMOur commitment to quality customer service, compassionate patient care, and filling critical healthcare needs makes us a trusted partner wherever care is needed. We offer private duty nursing, skilled nursing, physical rehabilitation, companion care, respite care and behavioral care for individuals with chronic and acute illnesses and disabilities.
NewDirector of Marketing & Public Relations | Lead Brand Strategy & Community Engagement in Healthcare The Staff PadDirector of Marketing & Public Relations | Lead Brand Strategy & Community Engagement in HealthcareLas Vegas, New MexicoThis role develops and executes strategic marketing plans, oversees advertising, publications, media relations, digital marketing, community outreach, and physician recruitment marketing while serving as the organization's primary media spokesperson. The Director of Marketing & Public Relations leads the organization's marketing, communications, and public relations efforts to strengthen brand awareness, support strategic growth initiatives, and promote healthcare services.
ViiV Healthcare (GSK) Regional Sales Director, Rocky Mountains Region GSK plcViiV Healthcare (GSK) Regional Sales Director, Rocky Mountains RegionAlbuquerque, NMRemote$182,250–$303,750 / yearKey Relationships to Drive Success (Internal & External) Marketing Senior Sales Leaders and current sales team Field Strategy and Operations Market Access Medical Science Liaison (MSL) Field Reimbursement Managers (FRM) Community Medical Liaisons/Contract Nurses HCPs - private practice, community clinics, and integrated systems Physician Support Staff Broader HIV community (Aids Service Orgs) Local business, regulatory and legal stakeholders Specialty Pharmacies Alternate Sites of Administration This role will provide YOU the opportunity to lead key activities to progress YOUR career, these responsibilities include some of the following: Managing the Business and Driving Performance Align and execute on business strategy marketing, market access pull-through, launches, multi-channel customer engagement, and employee development, to deliver exceptional results. 9+ years pharmaceutical sales experience including 6 plus years of specialty management experience leading teams Experience recruiting, developing and leading specialty teams to work cross functionally within an integrated account team model that includes multiple field-based team members.
Healthcare Quality Improvement Specialist (New Mexico) Tmf/C2CHealthcare Quality Improvement Specialist (New Mexico)New MexicoOversees, plans, facilitates, consults, implements, supports, and monitors activities needed to meet deliverables and activities for the project, including identifying issues, developing solutions, and continuously improving quality, processes, and efficiency. Oversees, develops, plans, creates, implements, analyzes, monitors, and distributes reports, logs, and other related documents, databases, and/or software within required timeframe and deadlines.
Commercial & Healthcare Regulatory Counsel Alto IncCommercial & Healthcare Regulatory CounselNMRemote$135,000–$185,000 / yearPhysical requirements for this role include the ability to work at a computer terminal with monitor, keyboard and mouse for extended periods of time, stoop, bend, and reach for equipment and supplies, make frequent repetitive motions required to operate a computer that include the wrists, hands and fingers, and lift, carry, push, pull, and move light objects up to 20 pounds. Issue-spot and provide practical guidance on applicable laws and regulations, such as the Anti-Kickback Statute (AKS), Stark Law, False Claims Act, FDA/DEA requirements relevant to pharmacy and telehealth operations, state pharmacy/professional licensing, PBM contracting/network participation, and HIPAA/HITECH.
Development Manager - Healthcare Technology MaximusDevelopment Manager - Healthcare TechnologyAlbuquerque, NMFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - Drive all aspects of engineering recruiting including but not limited to; attracting great talent and retaining a highly skilled, proficient engineering team.
Healthcare Controller Southwest CARE CenterHealthcare ControllerNMWorking in parallel with our veteran Accounting Manager, the Controller will lead the Financial Planning & Analysis (FP&A) function, oversee complex grant compliance, and drive the evolution of our Workday ERP system. This position supports all SCC locations in Santa Fe and Albuquerque; therefore, candidate must reside in the local market area of Albuquerque or Santa Fe, New Mexico and able to travel between the two cities as needed.
On-Site HealthCare Campus Recruiter BloomfieldOn-Site HealthCare Campus RecruiterBloomfield, New Mexico$65,000–$75,000 / yearFull timeCollaborate closely with the People Strategy Partner, establishing a seamless and positive onboarding experience for new hires, while strategically aligning on workforce planning, ensuring equitable compensation programs, and continuously refining selection criteria to drive organizational success. The Community Recruitment Partner serves as a key connector between our organization and the local community by building meaningful relationships to attract top talent while efficiently managing full cycle recruitment for clinicians.
On-Site HealthCare Campus Recruiter The Rehab Ctr of AlbuquerqueOn-Site HealthCare Campus RecruiterAlbuquerque, New Mexico$65,000–$75,000 / yearFull timeCollaborate closely with the People Strategy Partner, establishing a seamless and positive onboarding experience for new hires, while strategically aligning on workforce planning, ensuring equitable compensation programs, and continuously refining selection criteria to drive organizational success. The Community Recruitment Partner serves as a key connector between our organization and the local community by building meaningful relationships to attract top talent while efficiently managing full cycle recruitment for clinicians.
Senior Director, Physician Services Veracity Software IncSenior Director, Physician ServicesLas Cruces, NMThis leadership role is responsible for driving operational excellence, improving patient care delivery, and ensuring alignment with organizational goals across multiple physician practices. We are seeking an experienced and strategic Senior Director, Physician Services to lead and oversee physician practice operations in Las Cruces, NM.
Clinic Manager Goldbelt IncorporatedClinic ManagerNMGoldbelt Government Services, LLC, an Alaska Native Corporation, offers an experienced and effective team providing high quality staff augmentation, administrative management, project/program management, and education and training services to all federal agencies. Summary: The Clinic Manager for this Federal Law Enforcement Training Center (FLETC) site is responsible for the day-to-day management, supervision, and operational execution of enterprise health unit services supporting federal law enforcement training programs.
Manager Patient Access Ensemble Health PartnersManager Patient AccessAlbuquerque, New MexicoAdditionally, managing Financial Service Representatives and ensuring that proper accounting processes are followed, cash drawer is balanced, money is deposited timely and posted accurately to patient accounts, and proper logs are completed and submitted as requested by Financial oversight departments. Admitting staff are responsible for assigning accurate MRNs, completing medical necessity / compliance checks, providing proper patient instructions, collecting insurance information, receiving and processing physician orders, and providing excellent customer service.
Provider Program Manager (Provider Credentialing Required) TriWest Healthcare AllianceProvider Program Manager (Provider Credentialing Required)Albuquerque, NMRemoteFull timeAs part of an assigned team, develops effective collaborative relationships with TriWest's inter and intra-departmental stakeholders and other SMEs, C-Suite executives, and other leaders in Operations, Health Care Services, Provider Network, and IT to ensure that TriWest meets contractual requirements and fulfills organizational objectives. The Provider Program Manager ensures that strategic, enterprise-wide programs are well defined, planned, tracked, and communicated in a consistent manner; is responsible for collaborating with C-Suite executives and other stakeholders; and is responsible for deliverables that meet defined requirements and for utilizing project management best practices.
Provider Program Manager - Provider Strat Value Base Care TriWest Healthcare AllianceProvider Program Manager - Provider Strat Value Base CareAlbuquerque, NMRemoteFull timeAs part of an assigned team, develops effective collaborative relationships with TriWest's inter and intra-departmental stakeholders and other SMEs, C-Suite executives, and other leaders in Operations, Health Care Services, Provider Network, and IT to ensure that TriWest meets contractual requirements and fulfills organizational objectives. The Provider Program Manager ensures that strategic, enterprise-wide programs are well defined, planned, tracked, and communicated in a consistent manner; is responsible for collaborating with C-Suite executives and other stakeholders; and is responsible for deliverables that meet defined requirements and for utilizing project management best practices.
Chief of Staff to the Chief Operating Officer TriWest Healthcare AllianceChief of Staff to the Chief Operating OfficerAlbuquerque, NMRemoteFull timeTechnical Skills: Proficient in current trends in health care management with emphasis in customer service, network management, utilization and financial trends; collaboration skills to work with TriWest management team across multiple locations; networking skills with all levels, including subcontractors. • Works on multiple high level projects including logistical coordination, data analysis, contract management and written communications in support of various business initiatives of high visibility, applying project management tools and methodologies and leadership skills to meet or exceed deadlines.
Project Manager TriWest Healthcare AllianceProject ManagerAlbuquerque, NMRemoteFull timeTechnical Skills: Project management skills, including data analysis, facilitation and proficiency in the use of project management tools; ability to effectively interact and maintain effective working relationships with all levels of TriWest staff and with external shareholder organizations; ability to consistently meet meeting materials deadlines. Provides project management support for division and special company-wide projects and initiatives, supports TriWest's senior leadership with annual and day-to-day strategic and operational planning and projects, research activities, data analysis, drafts or edits plans and white papers related to specific initiatives.
Program Manager, Strategic Performance Excellence TriWest Healthcare AllianceProgram Manager, Strategic Performance ExcellenceAlbuquerque, NMRemoteFull timeThe Program Manager, Strategic Performance Excellence supports the development and execution of Corrective Action Plans (CAPs) in response to government-issued Corrective Action Requests (CARs) across the TRICARE (T-5) and Community Care Network (CCN) programs. In addition, this role partners with the Quality Performance Improvement team to integrate preventive insights and leading indicators from Quality Improvement Plans into project plans, timelines, and reporting to help mitigate risks before they escalate.
NewVendor Manager Alto IncVendor ManagerNMRemote$108,000–$135,000 / yearPhysical requirements for this role include the ability to work at a computer terminal with monitor, keyboard and mouse for extended periods of time, stoop, bend, and reach for equipment and supplies, make frequent repetitive motions required to operate a computer that include the wrists, hands and fingers, and lift, carry, push, pull, and move light objects up to 20 pounds. You'll be managing a broad portfolio of technology and services vendors across our five entities, driving governance into an estimated $10-15M of currently unmanaged spend, and working directly with Legal, Finance, Compliance, Security, and business leadership to make sure our vendor relationships are structured, compliant, and delivering value.
Director (Risk Management) Veracity Software IncDirector (Risk Management)Las Cruces, NMMotivation / Reason for Relocation (if not local to Las Cruces, NM 88011): Contact Number: Email ID: LinkedIn Profile URL: Full Address (Street, City, State, Zip Code): Notice Period (in weeks): Current Work Authorization Status: Expected Salary: Are you able to relocate on your own expenses and work in Las Cruces, NM 88011? . They manage the evolving needs of active litigation cases to include investigations, interviews, depositions, gathering of legal hold records and other needs as determined by legal counsel.
Clinic Manager - Osteopathic Medicine, Electrophysiology, and Neurosurgery Community Health Systems IncClinic Manager - Osteopathic Medicine, Electrophysiology, and NeurosurgeryLas Cruces, NMThis role involves coordinating healthcare services, optimizing clinic workflows, managing budgets, ensuring compliance with healthcare regulations, and providing leadership to a team of healthcare professionals. The Manager I, Clinics is responsible for overseeing the daily operations of a clinic or group of clinics, ensuring efficient delivery of patient care, and managing clinic staff.
Health Service Administrator- Rio Arriba Roadrunner Health ServicesHealth Service Administrator- Rio ArribaTierra Amarilla, NMFull timeManages changes in healthcare delivery systems or changes in contractual requirements impacting clinical program to include work restructuring, technological advancements and/or innovations, and shifts in the focus of care. Responsible for the planning, coordination, direction, and supervision of clinical program providing services to patients in a correctional setting to meet service delivery requirements of the specific contract.
Manager, Performance Briefing TriWest Healthcare AllianceManager, Performance BriefingAlbuquerque, NMRemoteFull timeMinimum of five years of experience gathering, analyzing, and composing technical information • Experience developing executive-level briefing materials and performance summaries for internal and external stakeholders • Demonstrated ability to coordinate across teams and synthesize large volumes of data into clear, actionable visuals and messages . • Drafts and revises performance specific content and briefings related to enterprise operational processes, contract and procedural changes, training materials, job aids, bulletins, functional procedures, workflows, templates, and other internal and external communications specific to briefings.
Director - Risk Management Veracity Software IncDirector - Risk ManagementLas Cruces, NMThey manage the evolving needs of active litigation cases to include investigations, interviews, depositions, gathering of legal hold records and other needs as determined by legal counsel. They manage risk identification, avoidance, and mitigation by collaborating all levels of leadership, provider, front end staff and other stakeholders.
Provider Program Manager- Provider Education TriWest Healthcare AllianceProvider Program Manager- Provider EducationAlbuquerque, NMRemoteFull timeAs part of an assigned team, develops effective collaborative relationships with TriWest's inter and intra-departmental stakeholders and other SMEs, C-Suite executives, and other leaders in Operations, Health Care Services, Provider Network, and IT to ensure that TriWest meets contractual requirements and fulfills organizational objectives. The Provider Program Manager ensures that strategic, enterprise-wide programs are well defined, planned, tracked, and communicated in a consistent manner; is responsible for collaborating with C-Suite executives and other stakeholders; and is responsible for deliverables that meet defined requirements and for utilizing project management best practices.
Director, Provider Experience TriWest Healthcare AllianceDirector, Provider ExperienceAlbuquerque, NMRemoteFull timeThe Director ensures the delivery of exceptional service to providers and government stakeholders by directing cross-functional programs that enhance provider satisfaction, strengthen network engagement, and uphold contractual and regulatory compliance. Coaching / Training / Mentoring: Actively develops the skills and capabilities of direct reports and extended team members through constructive feedback, mentoring relationships, and structured development opportunities aligned with business outcomes.
Principal IS Project Manager - Remote Providence St. Joseph HealthPrincipal IS Project Manager - RemoteAlbuquerque, NMRemoteTogether, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The Principal IS Project Manager (PM) position manages large, diverse, and complex projects that can span across multiple divisions and/or functional areas in Information Technology in collaboration with operational stakeholders.
Principal IS Project Manager - Remote Providence Health & ServicesPrincipal IS Project Manager - RemoteNMRemoteRequsition ID: 437964 Company: Providence Jobs Job Category: IT Administration Job Function: Information Technology Job Schedule: Full time Job Shift: Day Career Track: Business Professional Department: 4011 SS IS CRCA PPMO EPC PR Address: WA Renton 1801 Lind Ave SW Work Location: Providence Valley Office Park-Renton Workplace Type: Remote Pay Range: $See Posting - $See Posting The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Nurse Scheduling and Payroll Manager Albuquerque Hghts HC and RehabNurse Scheduling and Payroll ManagerAlbuquerque, New Mexico$24–$27 / hourFull timeOverview: Albuquerque Heights seeks an experienced Nurse Scheduling Manager At Genesis Healthcare, we are dedicated to improving the lives we touch through the delivery of high-quality care and exceptional service. *Lead nursing center's Labor Management Team to proactively manage the center's labor management performance against Key Performance Indicators to optimize clinical, financial and human resource operating results.
Health Service Administrator - Valencia County Roadrunner Health ServicesHealth Service Administrator - Valencia CountyNMFull timeManages changes in healthcare delivery systems or changes in contractual requirements impacting clinical program to include work restructuring, technological advancements and/or innovations, and shifts in the focus of care. Responsible for the planning, coordination, direction, and supervision of clinical program providing services to patients in a correctional setting to meet service delivery requirements of the specific contract.
Health Service Administrator - Lea County Roadrunner Health ServicesHealth Service Administrator - Lea CountyNMFull timeManages changes in healthcare delivery systems or changes in contractual requirements impacting clinical program to include work restructuring, technological advancements and/or innovations, and shifts in the focus of care. Responsible for the planning, coordination, direction, and supervision of clinical program providing services to patients in a correctional setting to meet service delivery requirements of the specific contract.
Mgr Clinical Appeals and Grievances HealthfirstMgr Clinical Appeals and GrievancesNM$103,400–$149,430 / yearPreferred Qualifications: • Experience in clinical practice with a focus in appeals & grievances, claims processing, utilization review or utilization management/case management • Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines • Extensive experience in healthcare appeals • MBA or master's degree from an accredited institution with focus in training & development, education, business, or healthcare administration • Management experience in an operational department within the healthcare industry focused on clinical leadership • Leadership experience in a focus area of operational excellence or audit • Experience developing strategy and processes for a department or function • Experience managing vendors as an extension of a core team • Familiar with creating accountable ownership of a vendor team. Minimum Qualifications: • Bachelor's degree from an accredited institution or equivalent work experience • RN • Experience with utilization management or appeals and grievance processing and compliance • Working experience in a fast-paced environment overseeing multiple priorities, tasks and/or teams • Proven track record of exercising independent thinking, ability to problem solve, understand process flows and correlating platforms to recommend and implement solutions • Experience preparing and delivering written and verbal information to multiple types of audiences • Demonstrated ability to build and foster effective relationships.
RN Case Manager - Truman Health Services UNM Medical Group, Inc.RN Case Manager - Truman Health ServicesAlbuquerque, NMRequest laboratory and radiology diagnostics; initiate blood work, blood cultures, transfusions and IVs; distribute specimens; follow-up on diagnostic results; provide direct patient care; record all patient care activities in chart and/or data base. State of New Mexico Licensed Registered Nurse or licensure pending as documented by temporary licensure OR current RN licensure from a state participating in the "multistate privilege to practice" compact with New Mexico.
Manager, Contract Deliverables TriWest Healthcare AllianceManager, Contract DeliverablesAlbuquerque, NMRemoteFull timeTechnical Skills: Advanced knowledge of Microsoft Word, Excel, Project, PowerPoint, Visio, and SharePoint; Ability to function without direction to produce outcomes within timelines; Proficiency with statistical analysis, project management skills, data analysis, benchmarking, and quality improvement concepts; Collaboration skills and team-oriented approach; Presentations and meeting facilitation skills. Examples of contractually required deliverables can include, but are not limited to, monthly, quarterly, and annual performance reports on contract execution, various Quality Assurance (QA) plans, financial reporting data, medical accreditation reports, and a wide variety of other data and progress reports.
Finance Director Veracity Software IncFinance DirectorLas Cruces, NMFull Name: Bachelor's Degree in Finance, Accounting, Business Administration, Healthcare Administration, or Related Field (Yes/No): Advanced Degree (MBA, MHA, Master's in Finance, etc.) (Yes/No – details): CPA, HFMA, FACHE, or other professional certifications (Yes/No – details): Total Finance / Revenue Cycle / Business Office Experience (Years): Total Leadership Experience (Years): Experience as a Finance Director, Controller, Business Office Director, or similar leadership role (Yes/No – provide details): Experience within a Healthcare/Hospital Environment (Years – brief details): Understanding of Healthcare Regulatory Compliance (HIPAA, CMS, Joint Commission, etc.) (Yes/No – brief details): Experience developing and managing departmental operating budgets (Yes/No – brief details): Motivation / Reason for interest in this position: If not local to Las Cruces, NM, why is the candidate interested in relocating to the area?. Directs and evaluates departmental operations, including patient care delivery, information technologies, service level determination, and complaint management, to achieve performance and quality control objectives.
Manager, Business Analytics CVS Health CorpManager, Business AnalyticsNM$66,330–$145,860 / yearThis involves extracting, analyzing, and interpreting contracting, utilization, financial, and clinical/quality data from various sources to support nationwide payer contract negotiations, market penetration, conversion, and expansion strategies, value-based care initiatives, and other quantitative analysis & reporting requirements. To develop and deliver decision support tools & insights via creating and sustaining analytics & reporting assets and leveraging business intelligence resources in support of contracting, financial and operational strategic decision-making by Retail Health leadership.
NewSurgery Center Administrator Macpower Digital Assets Edge Private LimitedSurgery Center AdministratorRio Rancho, NM$125,000–$145,000 / yearJob Summary: Responsible for directing, coordinating, and controlling all aspects of the operating functions, processes, and staff of the facility while demonstrating the primary goal of efficiently providing surgical services that exceed customer expectations and improve clinical and financial operations. Develop employee productivity analysis, utilizing Staff Tracker, and assure efficiency of staff levels through increases or reductions in the work force as necessitated by changes in surgical case volume.
Director of Risk Management HiredFirstDirector of Risk ManagementLas Cruces, NM$125,000–$150,000This individual will work closely with clinical and administrative leadership to develop and maintain programs that minimize organizational risk and support a safe care environment. This is a leadership role responsible for overseeing risk management functions at an acute care facility, with an expectation of regular in-person presence at the location.
Pharmacy Operations Manager Walgreen CoPharmacy Operations ManagerNM$22.50–$31 / hourAssists Pharmacy Manager in monitoring that all pharmacy and team member licensures, registrations and certifications are active and in good standing/ compliant with all regulatory and legal requirements. Where state and federal laws/regulations allow, accountable for performing day-to-day non-clinical pharmacy operations, administrative activities; Ensures efficient pharmacy workflow and a positive patient experience.
Nurse Scheduling and Payroll Manager Skies HC and Rehab CenterNurse Scheduling and Payroll ManagerAlbuquerque, New Mexico$24–$26 / hourFull timeLead nursing center's Labor Management Team to proactively manage the center's labor management performance against Key Performance Indicators to optimize clinical, financial and human resource operating results. As a leading provider in the long-term care industry, we believe in fostering a collaborative, inclusive and supportive work environment where every team member is valued and empowered to make a difference.
Contact Representative (PRC) US Department of Health and Human ServicesContact Representative (PRC)NM$45,409–$72,644 / yearGS-08: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-07 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: applying and interpreting complex federal, state, Tribal, and private-sector regulations to make eligibility and funding determinations for programs such as Purchased/Referred Care, Medicare, Medicaid, Veterans Affairs healthcare, and Affordable Care Act plans; independently analyzing medical, financial, and eligibility documentation to resolve complex or controversial benefit issues; coordinating with agencies, providers, and patients to ensure fiscal accountability and continuity of care; issuing medical authorizations or denial determinations based on regulatory, clinical, and fiscal requirements; maintaining fund control records, monitoring expenditures, and applying appropriate accounting codes; identifying and resolving program or funding discrepancies; and compiling and analyzing reports related to program operations, funding, and utilization. MINIMUM QUALIFICATIONS: GS-06: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-05 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: identifying and verifying patient eligibility for Medicare, Medicaid, SSA benefits, private insurance, Tribal programs, and other assistance resources; interviewing patients to obtain required documentation; assisting individuals and families with benefit applications; reviewing records to determine the status of claims and applications; responding to inquiries regarding patient eligibility requirements, benefits, and program guidelines; and maintaining accurate patient records through data entry, discrepancy resolution, and follow-up on pending claims and missing documentation.
Contact Representative (Benefits Coordinator) US Department of Health and Human ServicesContact Representative (Benefits Coordinator)NM$45,409–$72,644 / yearGS-08: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: interpreting and applying federal, state, Tribal, and third-party program regulations to determine eligibility and ensure compliance for programs such as Purchase Referred Care, Medicare, Medicaid, Affordable Care Act, Veterans Affairs Healthcare, and other alternate resources; conducting in-depth patient interviews to assess eligibility, verify coverage, and complete applications; registering eligible patients in various assistance programs; resolving claim denials and eligibility issues through coordination with patients, healthcare providers, and outside agencies; reviewing Medicaid eligibility information and supporting billing requirements; and utilizing effective oral and written communication to explain program requirements, provide referrals, and resolve complex patient service issues. MINIMUM QUALIFICATIONS: GS-06: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-05 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: determining patient eligibility for alternate resources programs; interpreting and applying Medicare, Medicaid, VA, and other third-party payer policies and procedures; conducting patient interviews to identify available healthcare coverage and funding sources; assisting patients with enrollment and claims processes; researching and resolving eligibility, denial, and reimbursement issues; maintaining effective working relationships with patients and resource agencies; and safeguarding confidential patient information in accordance with Privacy Act and HIPAA requirements.
Mgr,Clinical Qlty Improvement University of New MexicoMgr,Clinical Qlty ImprovementAlbuquerque, NMThe position will report to the Department Administrator and be responsible for advising and assisting the departmental Clinical Vice Chair, the Quality and Safety Officer, and other clinical and research faculty leaders with the development, preparation, interpretation, and monitoring of complex healthcare analyses, data projection, and reports used by clinical system management to advance value-driven outcomes for patients. Proficiency with a variety of tools (e.g., Cerner, REDCap, Tableau, Midas, Smartsheet, Microsoft products, etc.) will enable extraction of data, writing queries, developing programming logic, running of reports, manipulation of data, and analysis of datasets to meet the needs of the department.
Service Delivery Optimization Consultant - West Coast PhamilyService Delivery Optimization Consultant - West CoastAlbuquerque, NMPhamily, the company's core technology platform, has transformed chronic disease management with clinically tested AI and easy-to-use technology that enables physicians and care teams to offer high-touch, individualized patient care that has been proven to reduce investment in extra labor and the overall cost of care. For nearly a decade, the company has leveraged its easy-to-use, proprietary technology to enable health systems, medical groups, and ACOs to deliver high-quality, high-ROI proactive care to hundreds of thousands of previously underserved patients.
Strategic Performance Excellence Writer TriWest Healthcare AllianceStrategic Performance Excellence WriterAlbuquerque, NMRemoteFull timeCommunication / People Skills: Executive writing & storytelling; exceptional written communication skills with ability to synthesize complex technical and operational information; strong editorial judgment and structured writing discipline; ability to translate analytical findings into persuasive, defensible narratives; strong understanding of executive tone and government-facing professionalism. The Strategic Performance Excellence Writer serves as the enterprise writer and narrative architect for all Corrective Action Plans (CAPs) developed in response to government-issued Corrective Action Requests (CARs) across the TRICARE (T-5) and Community Care Network (CCN) programs.