- 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
- 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...in Health Care Administration, Public Health, Population Health, Finance, Business Analytics or related field and/or equivalent experience *… more
- Vanderbilt University Medical Center (Nashville, TN)
- …assembly of documentation and data to support analytical reporting to senior business operational leaders and physician leadership regarding: + Audit results to ... audit results. Monitors new regulatory and/or billing requirement changes from Medicare Administrative Carriers and CMS websites and published guidance. Performs… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** Leads business process improvement initiatives that result in operational efficiencies and/or an increase in customer ... satisfaction. Assists in development of MHI's business process improvement methodology and in the implementation of...+ Project management. + Process design & engineering. + Medicare . + Proven track record with results. + Process… more
- Guidehouse (Hanover, MD)
- …who serve them. Our Consultants help our clients improve their business processes, internal controls, operating efficiency, transparency and performance management, ... enhance their skills in the areas of technical competency, business development, client service and people development. As a... development, client service and people development. As a Consultant , you will work with an experienced team to… 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
- 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 ... St. Louis, MO, Wallingford, CT or Louisville, KY. The ** Business Information Developer Consultant - HEDIS Analytics**...+ Manages all measures and population reports for all Medicare projects. + Maintains HEDIS timelines used to support… 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 ... operating systems; minimum of 3 years experience as a Business Consultant with project management skills; or...risk adjustment and/or health insurance industry. + Experience in Medicare Advantage and Medicaid in a provider based or… more
- CareFirst (Baltimore, MD)
- …to travel into the local offices on occasion.** **PURPOSE:** The Sr. Pharmacy Business Consultant provides expertise in tailored, strategic, and critical work to ... initiatives tasks and goals. + Collaborate on Medicaid and Medicare Quality and Cost of Care business ...and Medicare Quality and Cost of Care business strategy, thesis, programs and the identification of strategic… more
- Humana (Columbus, OH)
- …health benefits organizations in the country. The Healthcare Strategy team supports Humana's Medicare and Medicaid business unit. This business unit, ... on Medicare Advantage strategy development. As a Insurance Strategy Consultant , you will deconstruct issues and challenges, perform targeted research and… more
- Trinity Health (Muskegon, MI)
- … Consultant will need:** **Minimum: Bachelor's degree in finance, business , counseling, social work, or job experience preferred.** + Preferred: Master's ... 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
- 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
- Fallon Health (Worcester, MA)
- …follow us on Facebook, Twitter and LinkedIn. **Brief Summary Of Purpose:** The Business Consultant I position provides support to the operational activities of ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)-… 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)
- …emphasis on the Medicare Managed Care Manual. + Expertise of core business processes related to payer practices. + Expert understanding of commonly used internal ... JOB REQUISITION Risk and Compliance - Healthcare Industry, Senior Consultant 2 LOCATION BOSTON ADDITIONAL LOCATION(S) NEW YORK CITY,...preparation of client proposals and strategies to win new business . + You have interest in working with a… 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 ... other duties as assigned. **Qualifications** Education and Experience: + Bachelor's degree business administration, finance, human resources, or a related field. + 5… 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
- Deloitte (Fort Lauderdale, FL)
- …Are you interested in helping clients drive alignment with their business , improve organizational and human resource performance and establish a culture ... focused on adding business value? That is what the new generation of...Work you'll do As a Government Health Actuary - Consultant in Deloitte's Human Capital Actuarial and Insurance Solutions… more
- Deloitte (Minneapolis, MN)
- …Are you interested in helping clients drive alignment with their business , improve organizational and human resource performance and establish a culture ... focused on adding business value? That is what the new generation of...Work you'll do As a Government Health Actuary - Consultant in Deloitte's Human Capital Actuarial and Insurance Solutions… more