- LA Care Health Plan (Los Angeles, CA)
- …process optimization, and enhancing the organization's compliance framework. The Regulatory Operations Advisor partners with internal stakeholders to provide ... Advisor Regulatory Operations Job Category: Administrative,...enhancing, and implementing comprehensive compliance programs and managed care operations for Medicare , Medicaid, and commercial health… more
- Elevance Health (Columbus, OH)
- …quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations . May identify cost of care ... ** Medicare Medical Director** Location: This position will work...be able to work Eastern Time Zone hours. The ** Medicare Medical Director** is responsible for the administration of… 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. Medical Mutual' s ... both tactical and strategic levels. The Insights & Analytics Advisor II possesses the technical skills and abilities to...voice of stakeholders and connect the dots to business operations . . Support senior consultants and team leader in… more
- Banner Health (AZ)
- …Arizona, Arizona **Department Name:** Sales **Work Shift:** Day **Job Category:** General Operations Your pay and benefits are important components of your journey ... optimal health, while reducing costs. POSITION SUMMARY This position directs the operations of Banner Plans and Networks government owned health plans including… more
- Humana (Columbus, OH)
- …to assigned health plan and/or specialty companies relative to Medicare /Medicaid/TRICARE/Employer Group product implementation, operations , contract compliance, ... and federal contract application submissions. The Market Development Advisor works on problems of diverse scope and complexity...or equivalent + 3 - 5 years experience with Medicaid/ Medicare /Employer Group operations + 3 - 5… more
- The Cigna Group (Morris Plains, NJ)
- **Product Management Advisor - Regulated Markets Communications** The Regulated Markets Communications team is responsible for all regulated lines of business ... including Medicare , Medicaid, and Healthcare Reform/Exchange Market. The team supports...Explanation of Benefits (EOB), and working cross-functionally to support operations , RFPs, and audits. Key Responsibilities: + Provides expert… more
- The Cigna Group (Bloomfield, CT)
- …Markets Services team is responsible for ensuring the execution of key operations accountabilities associated with all regulated lines of business including ... Medicare , Medicaid, and Marketplace (Exchange / Health Care Reform)....regulatory audit support, issue management and analytics. The Senior Advisor 's primary role will be to support Call Center… more
- Evolent (Columbus, OH)
- …connected care journey. We are hiring for a Senior Practice Performance Advisor to join our Provider Relations Team. **Collaboration Opportunities:** The Senior ... Practice Performance Advisor will be primarily responsible for primary care physician...in value based/full risk PCP MSO/IPA arrangements related to Medicare Advantage and other governmental programs + Experience in… more
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- …Centers for Medicare & Medicaid Services (CMS), Office of Strategic Operations and Regulatory Affairs, Regulations Development Group (RDG). As a Health Insurance ... Specialist (Technical Advisor ), GS-0107-14, you will you will serve as a...development across all areas of CMS programmatic responsibility, including Medicare , Medicaid, CLIA, CHIP, HIPAA, and private health insurance.… more
- The Cigna Group (Bloomfield, CT)
- …position has responsibility for several of the Pharmaceutical manufacturers for our Medicare , Commercial Government, LTC, and Managed Medicaid books of business as ... Supply Chain. + Interact with the Value Assessment Committee (Commercial and Medicare ) to develop and create product category strategies and pharma manufacturer… more
- Ascendis Pharma (Princeton, NJ)
- …skills. Ascendis Pharma is looking to hire an experienced Director, Contract Operations to join our team. Responsibilities will include implementing market access ... strong leadership, project management, and communication skills. As the Director, Contracting Operations , you will oversee all aspects of contracting operations ,… more
- Truecare Homecare Agency (Brooklyn, NY)
- …organizational resilience through risk management and process improvements. The Director of Operations will serve as a key advisor to executive leadership, ... related to nursing services, Medicaid waiver programs, and private pay operations . + Experience ensuring compliance with HIPAA, Medicaid/ Medicare , and… more
- Indian Health Service (St. Michaels, AZ)
- …American Indians/Alaska Natives (AI/AN). Responsibilities The incumbent serves as the primary advisor to the Director for Field Operations , Navajo Area ... as the Special Assistant to the Director of Field Operations , St. Michaels, Arizona. The primary function of this...standards, ie, The Joint Commission (TJC) , Centers for Medicare and Medicaid Services (CMS), etc., and the skill… more
- Molina Healthcare (Syracuse, NY)
- …is primarily in the Medicaid space, however, will cross over to Marketplace and Medicare . This role will lead by example, working alongside their team. There may be ... increase Medicaid assignment percentages for Molina. + Responsible for day-to-day operations and management of team members, including hiring, training, developing,… more
- Medical Mutual of Ohio (OH)
- …and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Responsibilities** Senior ... and Serving as a subject matter expert and trusted advisor to internal and external stakeholders. . Analyzes data,...stored. . Advanced to expert knowledge of health plan operations , data sources, and data structures, including trends and… more
- Alameda Health System (San Leandro, CA)
- …in the classification. 1. Actively participate in department meetings and operations , including process development or improvement. 2. Assures clinical interventions ... guidelines; refers questionable cases to the CM Manager or physician advisor for determination. 3. Collaborates and communicates regularly with contracted Health… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Design and execute ... . Serves as a subject matter expert and trusted advisor to internal and external stakeholders. . Contributes to...structured, and stored. . Strong knowledge of health plan operations , data sources, and data structures, including trends and… more
- Providence (Santa Monica, CA)
- …and prepares reports. + Ensures continuity and follow-through in daily operations . + Controls expenditures to within division-wide budgeted amounts. + Facilitates ... improvement, in addition to providing education on continual changes in Medicare regulation and reimbursement. + Form positive relationships with surrounding… more
- Elevance Health (Indianapolis, IN)
- …quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations . May identify cost of care ... Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare... Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs.… more
- Daiichi Sankyo Inc. (Basking Ridge, NJ)
- …support and solutions as a market access attorney and the primary legal advisor for market access and contract and pricing departments supporting US approved (or ... but not limited to, areas of GPO/PBM and trade/distribution agreements, Medicare , Medicaid, product pricing, and government price reporting. Coordination with, and… more