- Highmark Health (Harrisburg, PA)
- …are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with ... STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the needs… more
- Vanderbilt University Medical Center (Nashville, TN)
- …audit results. Monitors new regulatory and/or billing requirement changes from Medicare Administrative Carriers and CMS websites and published guidance. Performs ... Large Healthcare Environment, hospital, physician practice, third party payer, Medicare intermediary, health insurer, or accounting/consulting firm. (Required) 10… more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Performance Improvement Consultant , you will be responsible for: + Serving as a Subject Matter Expert (SME) ... offered by the health plan + Act as a consultant and partner to the contracted IPAs + Traveling...experience * Knowledge of HIPAA regulations * Knowledge of Medicare Advantage, STARS/HEDIS program, and NCQA technical specifications, a… more
- Molina Healthcare (Columbus, OH)
- …application of Lean/Six-Sigma. + Project management. + Process design & engineering. + Medicare . + Proven track record with results. + Process mapping tools - Visio, ... MS Project. + Power BI or Tableau. **Preferred License, Certification, Association** Lean Six Sigma Master Black Belt or Lean Sensei To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job… more
- Guidehouse (Hanover, MD)
- …technical competency, business development, client service and people development. As a Consultant , you will work with an experienced team to support the development ... of client deliverables, internal and client presentations, day-to-day project logistics, and any additional project tasks. This position provides individuals the opportunity to serve clients across a wide variety of functions including strategy, process… more
- VNS Health (Manhattan, NY)
- …analysis and interpretation designed to improve clinical outcomes. . Serves as consultant for unusual and difficult medical cases. Participates in the QARR/HEDIS ... Investigation Unit on issues related to Fraud, Waste, and Abuse of Medicare /Medicaid services.* Collaborates with pharmacy services to review PBM activities and… more
- Elevance Health (Atlanta, GA)
- ** Medicare Medical Director** Location: This position will work a hybrid model (remote and office). The ideal candidate will **must live** within 50 miles of one of ... our Elevance Health PulsePoint locations. The ** Medicare Medical Director** is responsible for the administration of...discuss review determinations. + Serves as a resource and consultant to other areas of the company. + May… more
- AccentCare, Inc. (Tampa, FL)
- …patient care. Salary: Schedule: Offer Based on Years of Experience Hospice Care Consultant Hospice Care Consultant Hospice Care Consultant Hospice Care ... Consultant Hospice Care Consultant Hospice Care Consultant Hospice Care Consultant Hospice Care ...of referral patterns. Experience with, or willing to learn, Medicare regulations and related reimbursement practices related to hospice… more
- MyFlorida (Tallahassee, FL)
- 68064188 - HEALTH SERVICES & FACILITIES CONSULTANT Date: Nov 20, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... Care Administration Working Title: 68064188 - HEALTH SERVICES & FACILITIES CONSULTANT Pay Plan: Career Service Position Number: 68064188 Salary: $1,794.92 Biweekly… more
- Trinity Health (Muskegon, MI)
- …reside in the West Michigan region. **What the Clinical Financial Consultant will need:** **Minimum: Bachelor's degree in finance, business, counseling, social ... medical field working with the financial needs of patients. Experience with Medicare health plans, COBRA regulations, Affordable Care Act Marketplace Plans, Medicaid… more
- Humana (Nashville, TN)
- …and help us put health first** The RN Senior Stars Improvement, Clinical Consultant / Professional executes the overall Medicare Stars Improvement Program within ... working relationship with the health plan. The RN Senior Stars Improvement Consultant / Professional: + Builds and maintains strong relationships with assigned… more
- Humana (Columbus, OH)
- …on Medicare Advantage strategy development. As a Insurance Strategy Consultant , you will deconstruct issues and challenges, perform targeted research and ... organizations in the country. The Healthcare Strategy team supports Humana's Medicare and Medicaid business unit. This business unit, Humana's largest, comprises… more
- HCA Healthcare (Nashville, TN)
- …**Job Summary and Qualifications** The Coding Operations Education and Appeals Consultant is responsible for assisting in the efficient and effective design, ... to understand, meet, and exceed customer expectations and needs. The Education Consultant is responsible for assisting in the development of the Quality Assessment… more
- Elevance Health (St. Louis, MO)
- **Business Information Developer Consultant - HEDIS Analytics** **Location:** This position will work a hybrid model (remote and in office one to two days per week). ... Louis, MO, Wallingford, CT or Louisville, KY. The **Business Information Developer Consultant - HEDIS Analytics** is responsible for developing and executing more… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. We are seeking an ... and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind… more
- WellSense (Boston, MA)
- Sr. Provider Relations Consultant - (MA residents)-$5,000 sign on bonus WellSense Health Plan is a nonprofit health insurance company serving members across ... Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide… more
- Elevance Health (Seven Fields, PA)
- **JR127301 Business Consultant Sr (Operational)** The Sr. Business Consultant will support the Advanced Primary Care risk adjustment team through vendor ... systems; minimum of 3 years experience as a Business Consultant with project management skills; or any combination of...risk adjustment and/or health insurance industry. + Experience in Medicare Advantage and Medicaid in a provider based or… more
- Elevance Health (Independence, OH)
- **Medical Policy Consultant ** National Government Services is a proud member of Elevance Health Companies, Inc. family of brands. We administer government contracts ... for Medicare and partner with the Centers for ...8 am - 4:30 pm EST.** The **Medical Policy Consultant ** is responsible for researching and drafting NGS Medical… more
- Robert Half (Boston, MA)
- JOB REQUISITION Risk and Compliance - Healthcare Industry, Senior Consultant 2 LOCATION BOSTON ADDITIONAL LOCATION(S) NEW YORK CITY, SAN FRANCISCO, SEATTLE JOB ... Protiviti is looking for a Risk and Compliance Senior Consultant to join our growing Healthcare team. What You...healthcare payer regulations and guidance with emphasis on the Medicare Managed Care Manual. + Expertise of core business… more
- MyFlorida (Tallahassee, FL)
- OPERATIONS & MGMT CONSULTANT MGR - SES - 65000081 1 Date: Nov 21, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... 841846 Agency: Elder Affairs Working Title: OPERATIONS & MGMT CONSULTANT MGR - SES - 65000081 1 Pay Plan:...(Serving Health Insurance Needs of Elders) program, SMP (Senior Medicare Patrol) Program, MIPPA ( Medicare Improvement for… more