- 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. Facilitates and ... option to work remote or hybrid; Ohio residents preferred._** **Responsibilities** ** Medicare Advantage Customer Experience Strategist** + **Facilitates projects… more
- 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
- LA Care Health Plan (Los Angeles, CA)
- Medicare Advantage Product Solutions Manager II Job Category: Administrative, HR, Business Professionals Department: Medicare Product Location: Los Angeles, ... on product agnostic initiatives as well as strategic partnerships. Medicare : Required Medicare Advantage , with experience serving duals population. Direct… more
- BlueCross BlueShield of North Carolina (NC)
- **Job Description** Are you an experienced actuarial professional with a passion for Medicare Advantage ? Join our dynamic team as a Senior Actuarial Analyst, ... advanced degree (where required). + Minimum of 4 years of experience in Medicare Advantage . + Completion of at least 5 actuarial exams towards the ASA… more
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and ... and CPT (II), and HCPCS coding systems required + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical specifications, required + Knowledge of … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …RoleThe Clinical Utilization Reviewer is responsible for facilitating care for our Medicare Advantage members who may have complex healthcare needs, authorizing ... levels of care). + Utilization Management experience, preferred + Experience with Medicare Advantage , preferred + Active licensure in Massachusetts is required,… 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)
- Description As the Medicare Advantage Risk Adjustment Performance Improvement Consultant, you will be responsible for: + Serving as a Subject Matter Expert (SME) ... management experience * Knowledge of HIPAA regulations * Knowledge of Medicare Advantage , STARS/HEDIS program, and NCQA technical specifications, a plus *… more
- CareFirst (Washington, DC)
- …The incumbent will have primary responsibility for issues related to Medicare / Medicare Advantage , prescription drugs, utilization management, and ... behavioral health. **ESSENTIAL FUNCTIONS:** The incumbents essential functions may include, but are not limited to, the following: + Serving as an internal resource to Public Policy, Government Affairs, Government Programs, Mandates and all other areas of… more
- UCLA Health (Los Angeles, CA)
- …do all this and more at UCLA Health. As an important member of our Medicare Advantage Operations team, you will be instrumental in maintaining and running ... required * Five or more years of experience with CMS processes in a Medicare or managed care environment * Must have 3-5 years of experience with Encounter… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. As member of the Medicare Advantage Risk Adjustment leadership team, the Assistant Director of Risk Adjustment is ... instrumental in participating in the planning with the director and other functional areas for implementation and execution of strategies, programs, supporting projects, and the monitoring of key performance indicators to enable operational excellence within… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. The ... Medicare Advantage Products Analyst plays an integral role in the product development of the Medicare Advantage . This role supports Medicare product… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. Medical Mutual' ... relating to the investigation of sales violations and complaints to the Medicare Advantage Sales Compliance area issued via Appeals and Grievances (A/G), the… 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. Implements and ... manages the implementation and daily operation of the Medicare Advantage Compliance Program and all compliance-related activities for the Company's Medicare … more
- AdventHealth (Altamonte Springs, FL)
- …work well with diverse teams, excellent analytical skills, a deep understanding of the Medicare Advantage program and data, and a high degree of creativity and ... and Excel to create custom reports and analyses for operators + Reviewing Medicare Advantage and ACO REACH data sets from payors for accuracy and validating… 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
- CareOregon (Portland, OR)
- …Summary This position is responsible for strategy, growth, and oversight of the Medicare Advantage line of business. Time is focused on enterprise-wide ... + Minimum 12 years' related experience, including 5 years' experience with Medicare Advantage plans + Leadership experience in a managed care organization or in… 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
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …for the compliant, accurate and timely billing and follow-up of all hospital Medicare and Medicare Advantage Patient Accounts. Essential Duties and ... a daily basis, but not limited as other tasks may be assigned. + Submit Medicare / Medicare Advantage plan claims both electronic and paper claims ( UB -04 and… more
- Humana (Miramar, FL)
- …the market, and translating these benefits into products offerings during the annual Medicare Advantage plan filing process. + Partner closely with Product ... Bachelor's Degree + Extensive leadership experience in the healthcare industry specifically Medicare Advantage + Proven track record of driving operational… more
Related Job Searches:
Business Analyst Medicare Advantage,
Medicare,
Medicare Advantage Actuarial Analyst,
Medicare Advantage Insurance Sales,
Medicare Advantage Plan Sales,
Medicare Advantage Product Manager,
Medicare Advantage Provider Performance,
Medicare Advantage Quality Consultant,
Medicare Advantage Sales,
Nurse Practitioner Medicare Advantage