- Elevance Health (Atlanta, GA)
- …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...of one of our Elevance Health PulsePoint locations. 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
- LA Care Health Plan (Los Angeles, CA)
- Compliance Advisor II Job Category: Administrative, HR, Business Professionals Department: Compliance Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... required to achieve that purpose. Job Summary The Compliance Advisor II ensures LA Care business units are compliant...of the Compliance Department and to support the business operations of LA Care Health Plan. Duties Analyze and… more
- Humana (Hartford, CT)
- …our caring community and help us put health first** The COS - Market Leadership Advisor manages the development, operations , and results of a health plan. The ... Market Leadership Advisor works on problems of diverse scope and complexity...that assigned health plans are meeting or exceeding corporate Medicare performance benchmarks and implementing the strategic plan. Maintains… more
- Humana (Columbus, OH)
- …and help us put health first** The Long-term Growth Strategy Advisor (Distribution) provides data-based strategic direction to identify and address business ... support for the Enterprise Growth vertical. The Long-term Growth Strategy Advisor 's work involves complex assignments performed without direction where the analysis… more
- Prime Therapeutics (Columbus, OH)
- …our passion and drives every decision we make. **Job Posting Title** Client Audit Advisor **Job Description** As a member of the Client Audit Management (CAM) team, ... the Client Audit Advisor is accountable for managing regulatory and/or client-initiated audits....+ 5 years of relevant work experience in compliance, operations , or external audit within a regulated environment +… more
- Humana (Arlington, VA)
- …caring community and help us put health first** The Acquisition Integration Advisor performs program management-oriented duties related to the integration of an ... and internal migration initiatives. This position resides within Humana's Strategy Operations organization within the Office of the Chief Corporate Development and… more
- Hackensack Meridian Health (Neptune, NJ)
- …adherence to intake process for each referral from start to hand off to operations for scheduling. Meet productivity standards on a daily basis. Maintain an accurate ... off to F2F team with appropriate information. + Knowledgeable in current Medicare reimbursement criteria and insurance contracts for the organization product lines.… 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
- 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
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- … advisor for various contracts throughout the Center of Medicare (CM). Responsibilities Responsible for planning, writing reports, conducting preparedness ... Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare...and Program Analyst, GS-0343-13, you will serve as an advisor to management in various administrative and operational areas… 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
- 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
- CVS Health (Springfield, IL)
- …PA & Appeals Operations . + Medicaid and Medicare Data Entry Operations for partially delegated clients. + Pharmacy Advisor (RxADV). + Medication Therapy ... execution in achieving operational excellence and compliance for Clinical Government Services Operations (CGSO), to include, but not limited to: + Commercial &… 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
- Adecco US, Inc. (Minden, NV)
- …within healthcare, behavioral health, or social services. Expertise in **Medicaid, Medicare , and medical billing** , coupled with strategic financial planning, is ... essential. This role also requires a business advisor who can provide operational insights to drive growth and development. If this sounds like you or someone you… 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
- New York State Civil Service (Rochester, NY)
- …at Treatment Team meetings, as well as assist in patient care and facility operations . * Serve as a health advisor to a multi-disciplinary team.* Participate ... eligibility for full and unconditional participation in the Medicaid and Medicare programs. Failure to maintain licensure, certification and/or Medicaid/ Medicare … more
- New York State Civil Service (Orangeburg, NY)
- …at Treatment Team meetings, as well as assist in patient care and facility operations . * Serve as a health advisor to a multi-disciplinary team.* Participate ... eligibility for full and unconditional participation in the Medicaid and Medicare programs. Failure to maintain licensure, certification and/or Medicaid/ Medicare … more