- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll provide direct management to a team of UM ... coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and...off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified Case Manager… more
- LA Care Health Plan (Los Angeles, CA)
- Medicare Advantage Product Solutions Manager II Job Category: Administrative, HR, Business Professionals Department: Medicare Product Location: Los ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....on product agnostic initiatives as well as strategic partnerships. Medicare : Required Medicare Advantage , with… more
- The Cigna Group (Denver, CO)
- …reporting and analysis within the Clinical & Data Science Analytics team for Medicare Strategic Analytics. Reporting to the Manager of Care Management Analytics, ... various care management initiatives. The Care Management Analytics team seeks to provide operational and analytical support to our partners to improve customer care… more
- The Cigna Group (Sunrise, FL)
- …the primary conduit to the providers and the individual that represents Cigna Medicare Advantage . The Provider Performance Enablement Lead Analyst's ... leadership including creating and delivering presentations. + Collaborating with Provider Performance Senior Manager / Manager on...members contribute to the growth and profitability of the Medicare Advantage business in their market in… more
- The Cigna Group (Seattle, WA)
- …Components:** All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: + ... experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage required + Ability to apply an enterprise mindset… more
- The Cigna Group (Atlanta, GA)
- …All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: **Growing ... candidate will work from local office 3 days per week.** The Provider Performance Enablement Advisor is an integral part of a cross-functional, collaborative… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans provide peace of mind to more ... the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and… more
- Point32Health (Canton, MA)
- …a team environment. + Strong understanding of the managed care industry, preferably Medicare Advantage plans. + Experience in Product Development. + Experience ... at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Senior Manager of Product Implementation and Administration will have two main… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans provide peace of mind to more ... the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare Advantage Plan visibility in the community by monitoring multiple ... performing all required tasks assigned by the Sales Field Manager . Incumbent will be responsible for educating and enrolling...issued by Centers Plans for Healthy Living MAP and Advantage Care Medicare HMO Plan. Enrollment application… more
- The Cigna Group (Austin, TX)
- …with cross functional teams and business partners. Performs actuarial analyses for Medicare Advantage business, including, but not limited to: medical expense ... analyses and projections, financial forecasts, Medicare Part C bid development, regulatory (CMS) bid submissions,...other internal meetings and presents on specific topics. + Provide guidance to stakeholders including product, finance and other… more
- Centene Corporation (Cheyenne, WY)
- … Medicare Supplemental benefits including dental, vision and hearing + Support Medicare Advantage bid development to determine product and benefit changes in ... levels, and value by leading the dental, vision and hearing Medicare Product development through strategy development, identify opportunities, plan, organize,… more
- G-TECH Services, Inc. (Detroit, MI)
- …be included in executive dashboard. * Assist with all functions related to Pharmacy Benefit Manager (PBM) oversight for Medicare Advantage Part D plans. * ... discussions. * Supports PBM audit and analytics to support Medicare pharmacy services business team. * Builds and supports...Receive and respond to plan related member and provider inquires. * Troubleshoot problems, inquiries, and provide… more
- Medical Mutual of Ohio (OH)
- …group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans provide peace of mind to more ... remote opportunity_** . **_Eastern & Central Time Zones preferred. Extensive Medicare Part D experience is highly sought after._** **Responsibilities** ** Medicare… more
- Corewell Health (Grand Rapids, MI)
- …Stars, HEDIS, CAHPS, Drug Adherence, and Member Experience + Experience with Medicare Advantage + Excellent analytical, organizational, and problem resolution ... in meetings with internal and external teams to improve Medicare Star ratings + Provide high-level, member...CMS requirements and standards + Other projects assigned by Medicare Quality Manager and/or Director How Corewell… more
- Elevance Health (St. Louis, MO)
- …very complex actuarial studies. **How you will make an impact:** + Insources Medicare Advantage Risk Adjustment Analytics from vendors. + Analyzes and implements ... provide an equivalent background. **Preferred skills, capabilities, and experiences:** Medicare Advantage and/or Medicaid Risk Adjustment experience is… more
- Trinity Health (Columbus, OH)
- …Day Shift **Description:** **Why MediGold?** MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and other ... market of Provider Relations Managers. The Market Manager Provider Relations and Network Development will...Working knowledge of protocols and procedures of Centers For Medicare and Medicaid . Services . Proven ability to… more
- The Cigna Group (Houston, TX)
- …Components All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: a. ... Role Summary The Provider Performance Manager is a key..._###@cigna.com_ _for an update on your application or to provide your resume as you will not receive a… more
- Molina Healthcare (Chicago, IL)
- …member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, ... in provider services, operations, and/or contract negotiations in a Medicare and Medicaid managed healthcare setting, ideally with different provider … more
- Medical Mutual of Ohio (OH)
- …group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans provide peace of mind to more ... self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and...issues regarding credentialing, claims, or other to the appropriate Provider Contract Manager or internal department; performs… more