- Unknown (Rancho Cucamonga, CA)
- …strategy across multiple product lines. The role demands expert knowledge of Medicare Advantage , Medi-Cal, and ACA risk adjustment methodologies and regulations, ... President of Risk Adjustment About the Company Prominent national healthcare plan provider Industry Hospital & Health Care Type Non Profit Founded 1995 Employees… more
- Unknown (Houston, TX)
- …progressive leadership experience in healthcare operations, with at least 3 years in Medicare Advantage , global risk, and delegated MSO settings, is required. ... collaboration, and ensuring the organization's infrastructure supports sustainable growth, financial performance , and superior member and provider outcomes. The… more
- Highmark Health (Buffalo, NY)
- …and provides strategic, hands-on, office based support to PCPs for analysis of performance Medicare STARS, Medicaid HEDIS and risk revenue streams, identifies ... are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with… 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 ... the overall financial performance and achievement of the budget of the Medicare plans within the Market. + Direction of senior leaders of specific functional… more
- Humana (South Miami, FL)
- …Based Role:** + **Deliver** : Build trust and educate individuals on Humana's Medicare Advantage plans and additional offerings like Life, Dental, Vision, and ... Humana apart. + **Grow** : Drive self-generated sales, meet performance goals, and expand Humana's presence in the market...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over… 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 ... for Performance (AP4P) Plan. This plan enables Intermountain Health to provide leaders with an additional performance compensation opportunity. The AP4P… more
- Fallon Health (Worcester, MA)
- …external SLA's. With speed, accuracy, and integrity, ensures that enrollee data for Medicare Advantage , Medicare Supplement, NaviCare, Summit Elder Care, ... improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and… more
- Henry Ford Health System (Traverse City, MI)
- …and planning and marketing support. Coordinate the development and implementation of Medicare Advantage sales strategies, compliance activities and oversight for ... is required. GENERAL SUMMARY: Responsible for the retention and growth of the Medicare line of business (both Individual and Group) accounting for more than $400… more
- Humana (Phoenix, AZ)
- …Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to ... of our caring community and help us put health first** The Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other… more
- Commonwealth Care Alliance (Boston, MA)
- …HOS) and value-based contract performance metrics + Experience with Medicare Advantage , Medicaid; and dually eligible populations **Desired Experience** + ... Provider Engagement, Network, Clinical and Quality teams to evaluate provider performance , identify opportunities for improvement, and facilitate data-driven… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Care Quality and Manager (CHQM) * Registered Nurse * Solid knowledge of Medicare Advantage Business Compensation and Benefits: Pay Range: $88,600.00 - ... HEDIS and Stars. Your Responsibilities As part of a Blue Cross provider - performance consultation team, this role * Identifies opportunities for provider … more
- CenterWell (Orlando, FL)
- …**Preferred Qualifications:** + Clinical experience in value-based primary care or Medicare Advantage . + Knowledge of EMR optimization, documentation workflows, ... to join our team as a Clinical Coding Education Facilitation Lead - Provider Coding Curriculums. In this role, you'll blend your clinical expertise-especially in … more
- Molina Healthcare (Dallas, TX)
- …member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, ... a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines… more
- ChenMed (Cincinnati, OH)
- …and mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to ... be America's leading primary care provider , transforming care of the neediest population. Our mission...goals, and when leading their care teams towards their performance goals. We are an outcomes-focused, value-based organization and… more
- Health Care Service Corporation (Chicago, IL)
- …Job Qualifications:** + MBA or MHA. + Health care industry experience. + Medicare Advantage knowledge and expertise. + Commercial, Affordable Care Act knowledge ... Delivery and network and value-based care program evolution, where high value provider partners are targeted for participation. Leader must work collaboratively with… more
- Centers Plan for Healthy Living (Queens, NY)
- …working weekends and requires frequent travel to various Centers Plans or Healthy Living Advantage Care Medicare HMO Plan sites located throughout the five (5) ... boroughs. Territory Management + Maintain Centers Plans for Healthy Living Advantage Care Medicare HMO Plan visibility in the community by monitoring multiple… more
- Humana (Tallahassee, FL)
- …builder, ensuring alignment with Humana's mission and Medicare Advantage goals. **Primary Responsibilities:** Clinical Engagement & Provider Strategy: ... those relationships to collaborate on how to positively drive provider performance , overcome operational barriers and reduce...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over… more
- Ventura County (Ventura, CA)
- …expertise in mental health billing, including CPT, ICD-10, and HCPCS coding for Medicare and Medi-Cal. Skilled in the Medi-Cal Provider Manual and TAR ... codes, Health Care Procedure Coding System (HCPCS) codes for payment processing of Medicare and/or Medi-Cal. + Medi-Cal Provider Manual for Billing and Policy… more
- Point32Health (Canton, MA)
- …Administration, or related field **Experience** + Required (minimum): 5 years in Medicare Advantage , Medicaid managed care, or healthcare product strategy. + ... including analysis of product performance and competitors + Monitor product performance throughout the year and provide data-driven performance … more
- Amazon (San Francisco, CA)
- …will responsible primarily for several critical workstreams which include analysis of Medicare Advantage and Accountable Care Organization data, design and ... performance compared to plan expectations. Key job responsibilities -Analysis of Medicare Advantage and Accountable Care Organization data primarily -Medical… more
