- 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
- UnitedHealthcare (Hopkins, MN)
- …including data analysis, Excel modeling, and other analytics in support of the Medicare Advantage bid process. You'll lead complex actuarial projects that have ... to make the health system work better for everyone. Primary Responsibilities: Prepare Medicare Advantage bids submitted to CMS annually Conduct data analysis and… more
- Abt Global Inc. (Rockville, MD)
- …least 5 years of experience working with Medicare , including Part D and Medicare Advantage , and Medicaid program and payment policy. + Deep familiarity with ... is contingent upon contract award to Abt Global. **Core Responsibilities** + Provide strategic leadership and direction for all project activities to ensure… more
- Commonwealth Care Alliance (Boston, MA)
- …**Desired Experience (nice to have):** + Experience working in a health plan, with Medicare Advantage and/or dually eligible population + Experience with a care ... oversight, routine and post discharge assessments, providing health education, and provider collaboration. Consults, as needed, with other participants of the… more
- Caris Life Sciences (Irving, TX)
- …Billing to support a seamless patient and provider experience. + Provide regular reporting and analysis of eligibility performance , including KPIs, denial ... cross-functional initiatives and manage timelines, resources, and deliverables. + Experience with Medicare Advantage plans and familiarity with Xifin is a plus.… more
- ChenMed (Richmond, VA)
- …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. * Leadership: Leads Super Huddle (SH) and… 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
- 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
- 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 ... 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
- 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
- Humana (Harrisburg, PA)
- …This includes the following key responsibilities: + Develop product strategy for annual Medicare Advantage plan filings + Lead the expansion and support for ... provider engagement activities for all lines of business + Medicare Advantage experience **Additional Information** This position will require approximately… 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
- Health Care Service Corporation (Chicago, IL)
- …CMS regulatory requirements, including Medicare Marketing Guidelines + Experience with Medicare products (including Medicare Advantage , Medicare ... and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The … 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
- Molina Healthcare (Kenosha, WI)
- …member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, ... Provider Services. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of… 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 (Oak Lawn, IL)
- …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 (Richardson, TX)
- …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
