- CVS Health (Salem, OR)
- …Board Certified in ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan ... Bring your heart to CVS Health . Every one of us at CVS ...care resources. **This is a remote based (work at home ) based anywhere in the US.** Responsibilities of this… more
- Walworth County (Elkhorn, WI)
- …and assistance with set-up/planning as needed. Perform home visits to home bound consumers regarding SeniorCare or Medicare Part D issues, including ... Medicare Specialist (HHS) Print (https://www.governmentjobs.com/careers/walworthco/jobs/newprint/3201106) Apply ...Elkhorn, WI Job Type Casual Job Number 2021-00139 Department Health & Human Services Division Aging & Disability Resource… more
- Humana (Leesburg, FL)
- … Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to ... our consumers. **_Face to face interactions in prospective members' home are a requirement for this position._** **Use your...help people with Medicare , or both Medicare and Medicaid, achieve their best possible health… more
- The Cigna Group (Bloomfield, CT)
- …representing over 40% of Cigna's total medical cost savings. The **NANPM Medicare Senior Advisor** is responsible for negotiating Medicare Supplemental ... facing and will directly oversee relationships between the Commercial and Medicare Advantage Segment encompassing Supplemental vendor relationships including but not… more
- Centene Corporation (Raleigh, NC)
- … materials and sales compliance. Participates in the ongoing oversight, analysis, review , and approval of all beneficiary-facing Medicare materials. In addition, ... , summarization and dissemination of key regulatory updates and changes with the Medicare Marketing Guidelines and relevance on material review . + Provides… more
- The Cigna Group (Bloomfield, CT)
- **Job Summary:** The Business Analytics Senior Advisor position within the Medicare Growth Analytics Team is an opportunity to provide leadership on our analytics ... strategy, to support our broader Medicare Growth team and provide actionable insights and analytics....end by managing variable tasks, stakeholder engagement and data review with limited supervision to meet targeted timelines. +… more
- Lowe's (Charlotte, NC)
- …Manager will be responsible for medically managing a minimum caseload of 65 including review of claims identified for Medicare Set-Aside. **What you will do** + ... treatment to an appropriate resolution. Apply medical treatment guidelines for future Medicare -covered expenses. The candidate will work directly for a Fortune 100… more
- The Cigna Group (Bloomfield, CT)
- …assistant or prior Medicare Claims experience + 2+ years' experience in Medicare Advantage Health Plans or related experience in a healthcare setting ... analysis of issues determine appropriate classification + Validate all assigned cases; review appeal documents, correct appeal types, timeframes and what is being… more
- Humana (Tyler, TX)
- …field sales community events, as well as, visiting prospects in their homes. Our ** Medicare Sales Field Agents** sell individual health plan products and educate ... part of our caring community and help us put health first** Total compensation package (base pay +commission with...on experience and location. Are you passionate about the Medicare population, looking for an opportunity to work in… more
- The Cigna Group (Austin, TX)
- …cross functional teams and business partners. Performs actuarial analyses for Medicare Advantage business, including, but not limited to: medical expense analyses ... and projections, financial forecasts, Medicare Part C bid development, regulatory (CMS) bid submissions, actuarial modeling/analysis, ad hoc actuarial… more
- The Cigna Group (Philadelphia, PA)
- Performs actuarial analyses for Medicare Advantage business, including, but not limited to: medical expense analyses and projections, financial forecasts, ... Medicare Part C bid development, regulatory (CMS) filings, actuarial...and CMS bid and supporting documentation development, support cross-market review of bids, and develop/update supporting forecasting and analyses.… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative… more
- The Cigna Group (Bluffton, SC)
- …either onsite, via webinar or by means of a desk review . Monitoring risk adjustment transactions include, amongst others, validating universes, preparing ... Bachelor's degree or equivalent. **5+ years of experience with Medicare Risk Adjustment-is required.** 5+ years of experience working...days a week. If you will be working at home occasionally or permanently, the internet connection must be… more
- The Cigna Group (Columbus, OH)
- …communication skills and executive presence + Excellent attention to detail + Health care/ Health insurance/ Medicare experience preferred. -or experience ... **Regional Marketing Manager (Senior Advisor), Medicare (TX/OK/AZ) - Remote** Reporting into the Senior...of strategies set by market and channel leadership. + Review , and present appropriate, requests for localized opportunities +… more
- The Cigna Group (Denver, CO)
- …conduit to the providers and the individual that represents Cigna Medicare Advantage. The Provider Performance External Representative's responsibilities include: + ... assigned territory. Participating with the Senior Manager/Manager in monthly financial review . + Assisting in initiatives and performing special projects and other… more
- The Cigna Group (Sunrise, FL)
- …conduit to the providers and the individual that represents Cigna Medicare Advantage. The Provider Performance Enablement Lead Analyst's responsibilities include: + ... with provider group on initiatives that benefit the customer, provider, and health plan. + Educating providers on the performance requirements associated with… more
- Molina Healthcare (Phoenix, AZ)
- … Medicare . **PREFERRED EDUCATION:** Master's in Business Administration, Public Health , Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- The Cigna Group (Seattle, WA)
- …with provider group on initiatives that benefit the customer, provider, and health plan. + Educating providers on the performance requirements associated with ... assigned territory. Participating with the Senior Manager/Manager in monthly financial review . + Assisting in initiatives and performing special projects and other… more
- Guidehouse (Lewisville, TX)
- …Chris Rivera (Manager, Talent Acquisition) at ###_** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + ... Would Be Nice To Have** **:** + Has active Medicare appeal process experience + PC skills in a...Retirement Plan + Basic Life & Supplemental Life + Health Savings Account, Dental/Vision & Dependent Care Flexible Spending… more
- The Cigna Group (Nashville, TN)
- …understanding of health plan operations, products and services, and general health plan trends and strategies, specifically Medicare Advantage plans + ... Assist with annual employee reviews, coaching, and corrective action plans + Review processes and understand critical control points and operational risk management… more
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