- 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
- The Cigna Group (Bloomfield, CT)
- **Role Summary:** This role will support Medicare Advantage bid goals and strategy by producing and maintaining value add analytics to influence decision making, ... Supports the evaluation and implementation of strategic initiatives to influence our Medicare Advantage annual bids. + Aids in both near and long-term analytics… 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
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Provider Documentation Trainer and Auditor, 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
- 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
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Senior Contact Center Representative, you will be addressing and resolving complex member inquiries, providing detailed ... in a Contact Center environment + Two or more years in a Medicare Advantage role, highly desired + Exceptional customer service and communication skills + Strong… 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)
- …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
- 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
- Providence (Beaverton, OR)
- …empower them._** **Providence Health Plan is calling an** HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA **who will:** + Perform internal coding audits ... of Hhierarchical Condition category (HCC) coding review for Risk Adjustment staff, contractors, and vendors + Perform audits to ensure compliance with national coding guidelines and industry regulations, as well as adherence to Providence Health Plan's coding… more
- The Cigna Group (Chattanooga, TN)
- …the total medical cost analytics for the Government Business Segment (Primarily Medicare Advantage business). This role will be responsible for developing ... medical expense analysis, detailed data drill downs of trend drivers, and execution of key initiatives designed to address medical cost trend. The ideal candidate will have a collaborative and creative mindset and be able to: + Creatively solve problems to… more
- The Cigna Group (Denver, CO)
- …reporting and analysis within the Clinical & Data Science Analytics team for Medicare Strategic Analytics. Reporting to the Manager of Care Management Analytics, the ... support to our partners to improve customer care and affordability for Cigna Medicare . This role will help us accomplish this through reporting, dashboards, and… 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
- 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 (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
- Providence (WA)
- …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
- BlueCross BlueShield of North Carolina (NC)
- …experience in related field. **What We'd Like** + Must have relevant experience in Medicare Advantage , Medicare Supplement and PDP. Preference for experience ... through product, program, market engagement and/or marketing communications strategies across all Medicare lines of business with a specific focus on Medicare … more
- Dignity Health (Phoenix, AZ)
- …**Responsibilities** Develops operates and administers the regulatory compliance program for both Medicare Advantage (Part C) and Medicare Part-D plan ... of SCHN. + Develops and monitors the implementation of and compliance with Medicare policies and procedures through the creation and implementation of a work plan.… more
- Carle (Urbana, IL)
- …REQUIREMENTS Two (2) years experience in compliance or health insurance with previous Medicare Advantage , or Part D experience. SKILLS AND KNOWLEDGE Knowledge of ... Medicare Compliance Analyst - HYBRID + Department: HA...a Friend Save Save Apply Now Position Summary: The Medicare Compliance Analyst is responsible for understanding, researching, interpreting,… more
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