• Senior Medicare Compliance Analyst

    Medical Mutual of Ohio (Brooklyn, OH)
    …perform pre-employment substance abuse and nicotine testing._ **Title:** _Senior Medicare Compliance Analyst_ **Location:** _OH-Brooklyn_ **Requisition ID:** ... and manages the implementation and daily operation of the Medicare Advantage Compliance Program and all ...Skills and Knowledge** . Working knowledge of Statutory and Federal Regulations that affect our various company products, specifically… more
    Medical Mutual of Ohio (11/27/24)
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  • Medicare Compliance Officer

    Centene Corporation (Austin, TX)
    …regarding new guidance from federal and state regulators ensuring that all Medicare Compliance policies and procedures are reviewed annually and revised, as ... member of Medicare & Compliance Senior Leadership, chairs Centene's Medicare Compliance Committee, attends meetings of the Enterprise Compliance more
    Centene Corporation (09/20/24)
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  • Senior Director, Compliance Advisory…

    Centene Corporation (Austin, TX)
    federal and state legal and regulatory requirements as it relates to Medicare compliance and HPMS/CMS regulations. + Oversee and monitor various of ... to assist with the development of public policy concerning federal managed care regulations and initiatives. + Represent senior...+ Oversee, administer, and implement various aspects of the Medicare Compliance program. + Provide guidance to… more
    Centene Corporation (11/28/24)
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  • Corporate Compliance ( Medicare

    CVS Health (Southfield, MI)
    …individual will work independently, as well as collaboratively, with internal senior level Medicare compliance and business teams that operate MMP and DSNP ... the CVS Code of Conduct * Maintains current working knowledge and expertise in Medicare Compliance , Medicaid Compliance and State regulations in support of… more
    CVS Health (10/16/24)
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  • Senior Medicare Communications…

    Centene Corporation (Raleigh, NC)
    …home anywhere in the Continental United States.** **Position Purpose:** Supports the Medicare Communications Compliance team in the management of regulatory ... requirements associated with the Medicare materials and sales compliance . Participates in...related field required. + Some experience in State or Federal managed care compliance and project coordination… more
    Centene Corporation (11/22/24)
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  • Business Process Owner Senior - Medicare

    USAA (Tampa, FL)
    …working Medicare / Medicare Supplement and products + Working knowledge of Medicare State and Federal Regulations + Working knowledge of Medicare ... currently seeking a dedicated **Business Process Owner Senior** that will support Medicare Supplement Claims for USAA Life Company Claims Operations. This employee… more
    USAA (10/23/24)
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  • Medicare Advantage Quality Consultant…

    Highmark Health (Harrisburg, PA)
    …models. This job is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue streams and provides strategic, hands-on, office ... based support to PCPs for analysis of performance Medicare STARS, Medicaid HEDIS and risk revenue streams, identifies...includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well… more
    Highmark Health (11/14/24)
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  • Medicare Sales Specialist (Remote…

    CVS Health (Nashville, TN)
    …talent! We have an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist. The position will be a part of a specialized team ... who will focus on educating existing Medicare members on available plan offerings to help meet...selling applicable products to existing members. + Maintaining high compliance commitment and standards with a robust knowledge with… more
    CVS Health (10/08/24)
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  • Senior Actuarial Analyst, Medicare Bid…

    Providence (WA)
    …to optimize performance + Analyzing and interpreting regulatory guidance to ensure compliance with Medicare Advantage bid requirements + Collaborating with ... empower them._** **Providence Health Plan is calling a Senior Actuarial Analyst, Medicare Bid who will:** + Be responsible for developing and maintaining actuarial… more
    Providence (10/31/24)
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  • Manager of Medicare Part D and EGWP…

    KPH Healthcare Services, Inc. (East Syracuse, NY)
    …and business partners. **Responsibilities** + Provide oversight of operational activities of Medicare Part D/EGWP programs + Ensure compliance with CMS rules ... **Overview** **The selected candidate must have** **5+ years experience in Medicare Part D and/or EGWP programs.** **Scope of Responsibilities:** Provides oversight… more
    KPH Healthcare Services, Inc. (11/29/24)
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  • Senior Medicare Coverage Analyst

    Dana-Farber Cancer Institute (Brookline, MA)
    …of research activity in an academic medical center + Knowledge of billing compliance and Medicare regulations/policy, applicable federal , state, and local ... including federal and state regulations. + Applies clinical guidelines, Medicare regulations, and study team guidance of conventional care to independently… more
    Dana-Farber Cancer Institute (10/22/24)
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  • Corporate Director, Population Health Clinical…

    AmeriHealth Caritas (Newtown Square, PA)
    …and ongoing improvement of Model of Care performance, contractual obligations, compliance with State and Federal regulations, and NCQA requirements. ... **Corporate Director, Population Health Clinical Operations, Medicare ** Location: Newtown Square, PA Primary Job Function: Medical Management ID**: 37990 **Job… more
    AmeriHealth Caritas (11/19/24)
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  • Dir, Medicare Segment Optimization

    Molina Healthcare (NM)
    …with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal , state and local regulatory requirements. ... **Job Duties** + Under the leadership of the VP Medicare Segment Lead, this role will facilitate transparent and...between segment, health plans, and shared services to drive compliance and performance objectives as well as provide oversight,… more
    Molina Healthcare (11/27/24)
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  • Manager, Actuarial Services - Medicare |

    Healthfirst (NY)
    **Duties and Responsibilities:** + Monitor experience under Healthfirst's Medicare line of business. + Provide support for annual Medicare bids for all ... analysis and other ad hoc analyses. + Research, evaluate and analyze Medicare market landscape. + Analyze product and segment performance, incorporating both… more
    Healthfirst (09/07/24)
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  • Director Medicare Telesales

    Healthfirst (NY)
    **Duties & Responsibilities:** + Develops, refines, and executes Medicare telesales strategy, including partnership with Dial America and across the various sales ... with supporting areas (eg, Analytics, Development, etc.) and stakeholders within the Medicare Sales team to define and implement enhancements to tele sales… more
    Healthfirst (11/08/24)
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  • Medical Director - National Medicare Team

    Humana (Columbus, OH)
    …evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical interpretation and determinations whether services ... and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. Supports the assigned work with respect to market-wide… more
    Humana (11/08/24)
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  • Sr Medicare Medicaid Biller Collector

    Prime Healthcare (Redding, CA)
    …in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare -Medicaid. This includes maintaining the ... military status, genetic information or any other basis protected by applicable federal , state, or local laws. The Company also prohibits harassment of applicants… more
    Prime Healthcare (11/13/24)
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  • Medicare Broker Manager - Las Vegas, Nevada

    CVS Health (Carson City, NV)
    …for ensuring broker adherence to all CMS and Aetna guidelines by monitoring compliance with state, federal , and health plan regulatory requirements. - Maintains ... Candidates will sit in the Las Vegas Nevada area** Aetna is looking for a Medicare Sales Broker Manager to join the Nevada sales team that drives and achieves sales… more
    CVS Health (11/05/24)
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  • Medicare Healthcare Internal Consultant…

    Vanderbilt University Medical Center (Nashville, TN)
    …of regulatory requirements pertaining to critical revenue cycle functions to promote compliance with federal and state regulations and organizational policies. ... to promote compliant actions regarding regulatory guidance and audits. Regulatory Compliance (Intermediate) - Demonstrates solid knowledge of federal and… more
    Vanderbilt University Medical Center (11/07/24)
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  • Medicare Broker Sales Manager, Licensed…

    The Cigna Group (Nashville, TN)
    …about the role:** **SUMMARY:** Responsible for the execution of the Cigna Medicare strategy for local topline sales agencies, directly contracted agents, and broker ... market goals . Adheres to and maintains current understanding of compliance requirements and organizational policies & procedures, marketing guidelines and broker… more
    The Cigna Group (11/07/24)
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