- Weisman Children's Rehabilitation Hospital (Marlton, NJ)
- …of three to five years directly applicable experience preferred.* Experience managing Medicare Advantage panel of patients with understanding of Best Practice ... care environment in a value-based relationship environment.* Knowledge of Medicare guidelines and coverage.* Knowledge of HEDIS quality indicators*Additional… more
- Body in Balance Physical Therapy (Fairfield, CA)
- …if you want or need toSoak up that communal feel, but take advantage of company benefitsResponsibilities:CD duties to include:Supervises and acts as a clinical ... appropriate documentation guidelines are being followed and in compliance with Medicare law.Monitors compliance with Quality Assurance Program guidelines and updates… more
- Highmark Health (Annapolis, MD)
- …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 a member of the Medicare Advantage Operations team, the Medicare Advantage Premium Billing Analyst plays a vital role in ensuring accurate ... accounts, and issuance of invoices. This position requires a deep understanding of Medicare Part D programs and meticulous attention to detail to maintain the… more
- Providence (Vancouver, WA)
- …your extraordinary care._** **Providence Health Plan is calling an Enrollment Specialist, Medicare Advantage and Supplements who will:** + Be responsible for ... group/centers, churches, homes, etc. to sell and promote the Providence Medicare Advantage Products + Travel throughout an assigned territory and work directly… more
- UCLA Health (Los Angeles, CA)
- Description As a member of the Medicare Advantage Operations team, the Medicare Advantage Enrollment Representative plays a crucial role in the ... guidelines; ensure timely, accurate and complete submissions to CMS - Medicare + Identifies continuous improvement initiatives to streamline processes, reduce member… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As a key leader within our Medicare Advantage team, you will develop and execute of strategies, programs, and projects ... clients. You will also serve as a Subject Matter Expert for Medicare Advantage risk adjustment. Salary offers are determined based on various factors including,… more
- CVS Health (Harrisburg, PA)
- …and affordable. Job Purpose and Summary: The Dental Director - Commercial and Medicare Advantage is an individual contributor who will assure that members ... + Basic knowledge of dental benefit products and platforms (DMO, PPO, Medicare Advantage ) + Strong understanding of value-based contracting options, clinical… more
- UCLA Health (Los Angeles, CA)
- …implementing, and maintaining accounting and finance functions for the newly formed Medicare Advantage health plan. Key Responsibilities include: + Leading, ... Director of Compliance, Director of Managed Care and Director of Medicare Advantage Operations regarding accounting for risk contracts. Provide advice on… more
- The Cigna Group (Columbus, OH)
- **Channel Marketing Director, Medicare Advantage - Hybrid** The Marketing Director will be responsible for leading the channel marketing team that supports the ... Cigna Medicare Advantage (MA) business. The MA business is a key business line within the larger Cigna Government business. The Marketing Director will have… more
- UCLA Health (Los Angeles, CA)
- …level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll provide direct management to a team of UM ... coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and manage various initiatives related to UM administrative,… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As a key member of our Medicare Advantage Operations team, you will partner with business and technical teams as well ... experience + Minimum of 5 years' experience in a Medicare or Managed Care environment managing enrollment, claims, premium...of 5 years' experience with CMS processes in a Medicare or Managed Care environment required + Project Management… more
- UCLA Health (Los Angeles, CA)
- …of Pharmacy Benefits Management! Reporting directly to the Chief Medical Officer of Medicare Advantage , you'll spearhead the development and oversight of our ... Care/PBM experience, highly desired + Two or more years of experience in Medicare programs, preferred + Degree from an accredited school of Pharmacy, required +… more
- The Cigna Group (Birmingham, AL)
- …group contracting and negotiations** + **Experience with Healthcare - Commercial and Medicare Advantage ** + Experience in developing and managing key provider ... relationships + Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred. + Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners. + Intimate… more
- UCLA Health (Los Angeles, CA)
- …do all this and more at UCLA Health. As an important member of our Medicare Advantage team, you will provide strategic oversight and leadership for our Member ... and Provider Contact Center. You will be responsible for ensuring the delivery of best-in-class service to new and existing members. You will lead, manage, coach, and develop teams to achieve high-performance standards in alignment with UCLA Health's mission… more
- UCLA Health (Los Angeles, CA)
- …Take on a key role within a world-class, award-winning health system. Contribute to the delivery of award-winning patient care. Take your career in an exciting new ... direction. You can do all this and more at UCLA Health. You will be responsible for accurate and timely data entry, and the review and adjudication of professional, ancillary, and institutional claims for services rendered in our inpatient, ambulatory and… more
- Intermountain Health (Columbus, OH)
- …and federal regulatory requirements. Enrolls customers who are eligible in the SelectHealth Medicare Advantage plan. **Essential Job Duties** 1. Primary point of ... contact representing SelectHealth Medicare Advantage products. 2. Answers calls from Medicare sales phone lines and Medicare Agent overflow calls. 3.… 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. Medical Mutual' ... or related industry, preferably in a call center environment. + Medicare Advantage and/or Part D experience preferred. **Technical Skills and Knowledge:** +… more
- Providence (OR)
- …data, and providing strategic insights to support the pricing and bidding process for our Medicare Advantage plans + Have a deep understanding of Medicare ... and providing critical insights to enhance the performance of our Medicare Advantage plans **_Please note the following important detail regarding this role:_**… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare Advantage Plan visibility in the community by monitoring multiple ... equipment issued by Centers Plans for Healthy Living MAP and Advantage Care Medicare HMO Plan. Enrollment application process + Ensures prospective members are… more
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