- 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
- Providence (Beaverton, OR)
- …that to inspire and retain the best people, we must empower them.** ** Medicare Advantage is a strategic growth strategy for PH&S and Providence Health Assurance. ... emerging markets. It will be managing and leading various enterprise-wide Medicare compliance-related initiatives and projects in relation to our delegated entities.… 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...successes in application of Lean/Six-Sigma. + Project management. + Process design & engineering. + Medicare . +… 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
- HealthEdge Software Inc (Columbus, OH)
- **Overview** **Overview:** The Business Consultant leads and mentors the Service Delivery team in all Tier 1 (Basic) and Tier 2 (Intermediate) consulting ... Source products (from basic to advanced features/functionality), payment methodologies/policies ( Medicare , Medicaid, and commercial), payment integrity, and healthcare plan… more
- Elevance Health (Woodlawn, MD)
- ** Business Information Developer Consultant ** **Location:** This position will work a hybrid model (remote and in office 1 - 2 days per week). Ideal candidates ... Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare...and Medicaid Services to transform federal health programs. The ** Business Information Developer Consultant ** will join a… more
- Stanford Health Care (Palo Alto, CA)
- …significant and sentinel events and to coordinate the root cause analysis process . HIGH-VALUE CARE: The Senior Quality Consultant -HVC supports the Director-HVC ... Day - 08 Hour (United States of America) As a Senior Quality Consultant in the Population Health Transformation Department, you will be instrumental in advancing… 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
- Adecco US, Inc. (Midwest City, OK)
- …and passionate professional to join our client's team! Position Name: **Membership Consultant ** Location: **Midwest City, OK** - 73110 Employment Type: Direct-Hire & ... 8am-5pm - No: weekends **Requirements** - Several years of Medicare Sales and Community Relations experience. - Experience with...patient's initial paperwork is complete. - Track the sales process through Salesforce CRM. - Spend majority of time… more
- Henry Ford Health System (Jackson, MI)
- SEPSIS FOCUS:The Principal Quality Consultant (PQC) position will lead the Henry Ford Jackson Hospital (HFJH) journey to improve sepsis care across the continuum. ... PQC will have direct oversight of the Centers for Medicare and Medicare SEP-1 core measure, including...Office of Clinical Quality and Safety, the Principal Quality Consultant is responsible for the facilitation of multiple Continuous… more
- Stantec (Orlando, FL)
- Benefits Consultant - ( 240004CC ) **Description** Grow with the best. Join a smart, creative, and inspired team that works to support operational excellence. The ... making our Company stronger. **Your Opportunity** We are looking for a Benefits Consultant specializing in compliance to join our HR Talent Services team! The… more
- CVS Health (New Albany, OH)
- …as a mentor to other analysts. **Required Qualifications** - Advanced knowledge of Medicare appeals process and the associated processing system - 7 or more ... care more personal, convenient and affordable. The Senior Analytic Consultant position is a 100% remote, work from home...whether the issues are resulting from clinical or administrative process related to appeals. + Perform ad hoc analysis… more
- Elevance Health (Walnut Creek, CA)
- … Sr.** for **Provider Success** is responsible for consulting with providers (Commercial, Medicare Advantage and Medicaid Lines of Business ) to assess and deploy ... to identify key opportunity areas and provider needs. + Consultant support model consists of a continuous process...vary depending on the above factors as well as market/ business considerations. No amount is considered to be wages… more
- IQVIA (Wayne, PA)
- …designing, enhancing, and executing commercial compliance programs. In this Senior Consultant role, you will support IQVIA's Commercial Compliance Consulting team on ... FAQs, etc.), training design support and training/communication strategy; + **Program and Process Design & Assessments** : Compliance program design, process … more
- Humana (Tallahassee, FL)
- …health first** The Humana Florida Team is seeking a Senior STARS Improvement Consultant / Professional who will work directly with the Stars Improvement Lead to ... Pharmacy development strategies. Additionally, the associate will engage with various business partners and be responsible for managing critical features of large… more
- Sedgwick (Chicago, IL)
- …containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of- business . + ... employees regain health and productivity, guide their consumers through the claims process , protect their brand and minimize business interruptions. Our more… more
- Highmark Health (Columbus, OH)
- …share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing ... key provider partners. + Collaborate with and support the senior Strategic Partners Consultant role as needed + Other duties as assigned or requested. **EDUCATION**… more
- Banner Health (AZ)
- …Networks. BPN has over 1 million members who are part of Commercial, Medicare Advantage, and Medicaid population. These members receive care from multiple provider ... in defining and building quarterly roadmaps that aligns with business and organization goals. The candidate will also define...on fact for all information feeds into the innovation process for respective areas. Promotes the use of data… more
- CVS Health (Springfield, IL)
- …travel is required. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to ... Thursday, Friday, Saturday, Sunday 8:00am to 7:00pm CST with holiday rotation per business needs. Utilization Management is a 24/7 operation and work schedules may… more
- Atlantic Health System (Morristown, NJ)
- Essential Job Functions: + Candidate will have the ability to utilize the nursing process to assess, diagnose, plan, implement and evaluate the plan of care for ... Partner of the New York Jets + NJ Sustainable Business Morristown Medical Center is a nationally-recognized leader in...highest - twelve consecutive times, and the Centers for Medicare and Medicaid Services awarded us again with its… more
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