- University Health (San Antonio, TX)
- …efforts, and reviewing HCC quality indicators, and RAF scores to eligible Medicare Advantage beneficiary. Will monitor opportunities within the Medicare ... Will coordinate the transition of care and the interdisciplinary treatment for Medicare managed patients across the healthcare continuum. Facilitates the delivery of… more
- Endeavor Health (Elmhurst, IL)
- …Performs provider audits on E/M (evaluation/management) services and HCC review on Medicare / Medicare Advantage preventive services and educates providers as ... needed. Trains physicians and other staff regarding documentation, billing and coding, and documentation. What you will need: Education: Bachelor's or associate degree in a Health Information Management program accredited by the Commission on Accreditation for… more
- Optum (Dallas, TX)
- …care setting and working with medically complex patients Working knowledge of Medicare Advantage Risk plans Understanding of HEDIS measurements and delivering ... value-based care Compensation for this specialty generally ranges from $229,50 to $378,000. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may… more
- Arcadia Home Care and Staffing - an Addus family company (Shasta Lake, CA)
- …BENEFITS WITH NO MINIMUM HOURS REQUIRED TO QUALIFY IN THE FIRST YEAR. Take advantage of this unique opportunity to learn the fundamentals of quality home care and ... and is flexible to meet the needs of the department. Follow all Medicare , Medicaid, and HIPAA regulations and requirements. Abide by all regulations, policies,… more
- Highmark Health (Buffalo, NY)
- …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
- CVS Health (Blue Bell, PA)
- …in this role will serve as the subject matter expert for Aetna's Medicare Advantage Special Needs Plans (SNP) business. Includes Dual Eligible, HIDE/FIDE ... Chronic plans. The SNP population presents a huge growth opportunity for Medicare Advantage plans, and Aetna is aggressively expanding into this market. This… 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. This position ... of Medical Mutual's Medicare Compliance Program, which supports both Medicare Advantage and Medicare Supplement products. Reporting directly to the Chief… 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
- Humana (Sanford, FL)
- …Based Role:** + **Deliver** : Build trust and educate individuals on Humana's Medicare Advantage plans and additional offerings like Life, Dental, Vision, and ... Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help… more
- CVS Health (Downers Grove, IL)
- …with internal senior level corporate compliance and business teams that operate Medicare Advantage in a highly complex regulatory environment and highly ... and teamwork **Required Qualifications:** + 7+ years' experience in Medicare or Medicare Advantage government healthcare program compliance or regulatory… more
- UCLA Health (Los Angeles, CA)
- …Senior Product Manager to lead the design, development, and implementation of our Medicare Advantage products. In this role, you'll partner with the Director ... and compliance throughout the member lifecycle. Key Responsibilities: + Lead end-to-end Medicare Advantage product development. + Support and help manage the… more
- Humana (Providence, RI)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience… more
- CVS Health (Concord, NH)
- …of medical costs management, compliance, and revenue integrity efforts for all Medicare Advantage products (inclusive of collaborating with the Employer Group ... every day. Aetna is recruiting for an AVP, General Manager who has Medicare market specific P&L accountability for the IVL/DSNP products in their market, supporting… more
- Erickson Living (Tinton Falls, NJ)
- …benefits. + Be knowledgeable of all applicable CMS regulations and guidelines of specific Medicare Advantage Plans. + Create sales events intended to allow new ... Village by Erickson Senior Living We are hiring a Medicare Sales Agent, also known as our Health Insurance...and their families on matters pertaining to the Erickson Advantage Health Plan and insurance matters in general. Erickson… more
- Commonwealth Care Alliance (Boston, MA)
- …ensuring accurate, compliant, and timely reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director of ... Experience (nice to have):** + Prior experience working with MassHealth and Medicare Advantage reimbursement rules is strongly preferred. **Required Knowledge,… more
- Robert Half Office Team (Kansas City, MO)
- …turn into a contract to hire opportunity. 100% Onsite. Responsibilities: + Sell Medicare Advantage plans, Medicare Supplement plans, and related products ... Description We are looking for a dedicated Licensed Medicare Specialist to join an insurance company in Kansas City, Missouri. This is a long-term contract position… more
- Humana (Harrisburg, PA)
- …This includes the following key responsibilities: + Develop product strategy for annual Medicare Advantage plan filings + Lead the expansion and support for ... contracting and provider engagement activities for all lines of business + Medicare Advantage experience **Additional Information** This position will require… more
- Intermountain Health (Murray, UT)
- …needed to develop a strong performing product. **Preferred Qualifications** + Knowledge of Medicare Advantage products, which could come from work experience in ... Partner leads the development and management of a portfolio of high-impact Medicare products within the government programs division at Select Health, overseeing… more
- Southeast Health (Dothan, AL)
- …Using internal and external computer systems and payer portals, work traditional Medicare and Medicare Advantage /Replacement inventory to full resolution. ... to obtain accurate reimbursement; + Understands the use of and navigation of Medicare 's DDE system and other governmental and commercial payer websites for claim… more
- CVS Health (Chicago, IL)
- …priorities and deadlines **Preferred Qualifications** + Prior Pharmacy, Part D, or Medicare Advantage experience + ASA **Education** + Bachelor's Degree ... is primarily responsible for modeling pharmacy network contracting arrangements for Aetna's Medicare Part D business and providing actuarial support to key business… more
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