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.
Lead Director, Healthcare Medicaid Risk Adjustment Analytics CVS Health CorpLead Director, Healthcare Medicaid Risk Adjustment AnalyticsNM$100,000–$231,540 / yearThe Lead Director should also demonstrate leadership in innovation and adoption of modern technologies, data platforms, machine learning, process automation, AI, and data science for optimized insights, workflows, reporting, and process controls. This senior-level role will provide strategic and operational leadership for all Medicaid risk adjustment analytics, reporting, and informatics functions to ensure complete, accurate, and compliant revenue capture.
Principal Financial Implementation Consultant (Healthcare) Workday IncPrincipal Financial Implementation Consultant (Healthcare)NM$140,300–$210,500 / yearWe know that flexibility can take shape in many ways, so rather than a number of required days in-office each week, we simply spend at least half (50%) of our time each quarter in the office or in the field with our customers, prospects, and partners (depending on role). As an experienced financial functional consultant, you will play a key role in ensuring the successful implementation of Workday's financial solutions for our healthcare customers and guiding them through transforming their financial operations.
Technical Support Analyst IT Help Desk Healthcare Southwest CARE CenterTechnical Support Analyst IT Help Desk HealthcareNMCandidate Highlights: Experience: Minimum (1) year of hands-on hardware troubleshooting experience, with working knowledge of electronic medical record systems and experience working in a healthcare environment highly desired. Deliver required desktop service levels by installing, configuring, testing, maintaining, monitoring, and troubleshooting end-user workstations and related hardware and software.
Strategic Account Executive - Healthcare UKGStrategic Account Executive - HealthcareSanta Fe, NM$90,000–$95,000 / yearThis Account Executive will be in a role of focusing on both acute and non-acute care accounts between 1-500 employees; the role requires a hunter focus on existing accounts seeking to add on Payroll, HR, Talent, Benefits, and additional HCM products, as well as expanding their labor management solution with additional products such as absence management, scheduling, and the analytics solutions. This person will be tasked with creating and maintaining key stakeholder relationships, in the accounts, and maximize opportunities to attain and exceed annual sales goals for the territory and the UKG Healthcare sales team.
Senior Healthcare Internal Audit Consultant Banner HealthSenior Healthcare Internal Audit ConsultantNMRemote$43.77–$72.95 / hourMust possess one of the following certifications within 12 months of hire: Professional designations such as Certified Public Accountant (CPA), Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE), or Certified Healthcare Internal Audit Professional (CHIAP). Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.
Director Product Management - Health Data Interoperability CVS Health CorpDirector Product Management - Health Data InteroperabilityNM$144,200–$288,400 / yearWorking closely with Engineering, Clinical Informatics, Customer Success, Business Development, and Executive Leadership, this role translates market opportunities, regulatory requirements, and customer needs into scalable product solutions that improve healthcare connectivity, operational efficiency, and patient outcomes. This leader will manage a team of 4-5 Product Owners and drive innovation across data exchange platforms, interoperability services, APIs, and healthcare integration capabilities that enable seamless, secure, and compliant information sharing across the healthcare ecosystem.
Manager Contract Administration Presbyterian Healthcare ServicesManager Contract AdministrationNMSummary: The Contracts Administrator assists Presbyterian Healthcare Services control costs, drive service excellence, and mitigate risks to gain increased value from our vendors throughout the contract management lifecycle. The Contracts Administrator will work closely with internal business, project managers, Finance, Supply Chain, Legal, outside counsel, and external vendors to ensure compliance with all relevant laws, regulations, and PHS policies and procedures.
Pharmacy Operations Manager Walgreen CoPharmacy Operations ManagerEspañola, NM$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.
Project Manager - Full time, Day, Onsite Providence Health & ServicesProject Manager - Full time, Day, OnsiteNew Mexico, NMRequsition ID: 455236 Company: Providence Jobs Job Category: Project Management Job Function: Project/Product Management Job Schedule: Full time Job Shift: Day Career Track: Business Professional Department: 4007 SS CC PROG SRVC Address: WA Renton 1801 Lind Ave SW Work Location: Providence Valley Office Park-Renton Workplace Type: On-site 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.
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)San Felipe Pueblo, 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.
NewC&S CMO New Mexico UnitedHealth Group Inc.C&S CMO New MexicoSanta Fe, NM$292,300–$438,500 / yearPrimary local responsibility is to drive PCCM/Accountable Care Community (New Mexico's Patient Centered Medical Home) growth through identification of appropriate practices; initial contact and target setting, and Implementation, as well as ongoing leadership during regular Joint Operating Committees (JOCs.) Furthermore, healthcare transformation is a priority focus of the CMO by continuously advancing a clinical model that engages underserved individuals in a population health model that is supported by integrated community care teams and over 3,000 providers in a value-based payment model.