- Molina Healthcare (Fresno, CA)
- …different provider types (eg, physician, groups and hospitals). + **Experience with Medicare Advantage and Medicare .** + **Experience with Value Based ... Contracting.** + **Ability to drive Provider Performance .** + **IPA Network Management experience.** To all current Molina employees: If you are interested in… more
- HCA Healthcare (Nashville, TN)
- …(CMMI) projects; Accountable Care Organizations (ACO); Advanced Alternative Payment Models; Medicare Advantage including HEDIS performance ; commercial pay ... (CMMI) projects; Accountable Care Organizations (ACO); Advanced Alternative Payment Models; Medicare Advantage including HEDIS; and commercial payer value… more
- Highmark Health (Dover, DE)
- …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
- LA Care Health Plan (Los Angeles, CA)
- Medicare Advantage Product Solutions Manager II Job Category: Sales & Marketing Department: Medicare Product Location: Los Angeles, CA, US, 90017 Position ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....partnerships inclusive of entry onto the Covered CA market. Medicare : Required Medicare Advantage , with… 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, ... approach to the actuarial components of health programs. + Provide actuarial support to Network Management, Underwriting, Sales and...required). + Minimum of 4 years of experience in Medicare Advantage . + Completion of at least… more
- UCLA Health (Los Angeles, CA)
- …bids or product lines within a health insurance company, managed care organization, or Medicare Advantage provider . * Deep understanding of CMS regulations, ... product updates to senior leadership and stakeholders. * Track performance to inform future strategy and improvements Salary Range:...Medicare Advantage , Prescription Drug Plans (PDP), Medicare programs,… more
- CVS Health (Trenton, NJ)
- …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
- Child & Family Services of RI (Middletown, RI)
- …in or updating their Medicare Prescription Drug Plans (Part D) or Medicare Advantage Plans (Part C). * Promotes awareness, knowledge, and visibility for ... What You'll Be Doing You will provide outreach and assistance to eligible Medicare...status, physical or mental disability that does not prohibit performance of essential job functions with or without reasonable… more
- Humana (Pierre, SD)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other ... Utilization management experience in a medical management review organization, such as Medicare Advantage , managed Medicaid, or Commercial health insurance. +… more
- Humana (St. Augustine, FL)
- …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 ... on experience and location. Are you passionate about the Medicare population, looking for an opportunity to work in...applicants selected for leader review may be asked to provide their social security number, if it is not… more
- Molina Healthcare (Richmond, CA)
- …member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, ... Website, etc.). * Medicare subject matter expertise * Trains other Provider Relations Representatives as appropriate. * Role requires 60%+ same-day or overnight… more
- CenterWell (Lincoln, NE)
- …Management, (VBC) Value Based Care and/or healthcare operations setting, preferably in Medicare Advantage programs. **Additional Information** + 100% remote role ... caring community and help us put health first** The National leader, Provider Education builds strategies for development, engagement, best clinical practices and… more
- VNS Health (Manhattan, NY)
- …including ICD 10 CM or current coding system and medical record systems for Medicare Advantage Risk Adjustment required + 2 years of experience in coding ... looking for a motivated and dynamic Risk and Quality Provider Educator to travel to provider practice...their quality of life and avoid complications. You'll review performance metrics and patient charts, identifying opportunities to support… more
- Molina Healthcare (Las Vegas, NV)
- …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 (Madison, WI)
- …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
- Boehringer Ingelheim (Ridgefield, CT)
- …to the design of and development of a Patient Services strategy to provide the optimal patient & provider experience across reimbursement, HUB services, ... may be eligible for a role specific variable or performance based bonus and or other compensation elements. For...patient support program services for assigned product (s) to provide the optimal patient & provider experience… more
- ChenMed (Decatur, GA)
- …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
- AdventHealth (Maitland, FL)
- …documentation both for clinical quality and financial performance across the Medicare , Medicare Advantage , and Exchange populations. o Driving engagement ... on all contracts and business lines, including Direct-To-Employer, Commercial, ACA Exchange, Medicare , Medicare Advantage , Bundles, and other Network… more
- Centers Plan for Healthy Living (Bronx, 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
- Convey Health Solutions (Chicago, IL)
- …highly motivated Project Manager to lead initiatives that support and enhance the Medicare Advantage Star Ratings solutions and services. This individual will ... The ideal candidate will possess a deep understanding of Medicare Advantage plans, the Star Ratings system,...Advantage Star Ratings or in a similar quality performance role. * Proven track record of managing cross-functional… more