- 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
- 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
- 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 (Seven Fields, PA)
- **JR127301 Business Consultant Sr (Operational)** The Sr. Business Consultant will support the Advanced Primary Care risk adjustment team through vendor ... engagement, reporting and identifying areas for process improvement. The ideal candidate will have a healthcare...operating systems; minimum of 3 years experience as a Business Consultant with project management skills; or… 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
- 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 ...+ Review and support task coordination while identifying potential process improvements. + Develop and finalize budgets, policies, and… 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
- 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
- Trinity Health (Muskegon, MI)
- … Consultant will need:** **Minimum: Bachelor's degree in finance, business , counseling, social work, or job experience preferred.** + Preferred: Master's ... to resources and data collection in accordance with the process identified. This position is on site and the...working with the financial needs of patients. Experience with Medicare health plans, COBRA regulations, Affordable Care Act Marketplace… 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, ... all coding operations education components and an effective coding appeals review process for the HCA Physician Services Group (PSG). The education program… 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 ... knowledge of commercial/regulatory health insurance industry including various lines of business + Comprehensive understanding of process re-engineering +… 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 ... and HRIS job tables and reporting. + Administers the annual merit process ; recommends merit budgets and salary range movement and models costs.Develops timelines,… more
- Elevance Health (Columbus, OH)
- … 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...They are how we achieve our strategy, power our business outcomes and drive our shared success - for… more
- Elevance Health (Atlanta, GA)
- **Director I Care Consultant ** **Location:** This position will work a hybrid model (remote and office). Must reside within 50 miles/1 hour commute of our Atlanta or ... Columbus, GA, Elevance Health locations. The **Director I Care Consultant ** is responsible for strategy and implementation of Provider Success programs in the state… 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 (Brea, CA)
- …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
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