- Highmark Health (Buffalo, NY)
- …the Organization are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for ... STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- … Quality and Manager (CHQM) * Registered Nurse * Solid knowledge of Medicare Advantage Business Compensation and Benefits: Pay Range: $88,600.00 - $117,400.00 ... Blue Cross and Blue Shield of Minnesota Position Title: Quality & Risk Adjustment Provider Consultant Location:...Position Title: Quality & Risk Adjustment Provider Consultant Location: Hybrid | Eagan, Minnesota Career Area: Customer… more
- OhioHealth (Columbus, OH)
- …delivery model. This includes the OhioHealth Clinically Integrated Network (CIN) Medicare Advantage and Commercial contracts, OhioHealth Venture Medicare ... our careers and in our communities. **Job Description Summary:** The Senior Consultant , Value Based Contract Performance is charged with supporting teams in solving… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …experience will be considered. * Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment. * Certified Risk Adjustment Coder (CRC) ... The Impact You Will Have As a Risk Adjustment Quality Assurance (QA) Consultant at BCBSMN, you'll...certification * In-depth knowledge of ACA & Medicare Advantage risk adjustment methodology, coding guidelines… more
- Humana (Sacramento, CA)
- …Insurance segment's highest priority projects and initiatives, with an emphasis on Medicare Advantage strategy development. As a Senior Strategy Advancement ... initiatives and business areas, evolving key facets of the Medicare Advantage growth strategy, leading the development...need it. These efforts are leading to a better quality of life for people with Medicare ,… 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
- CenterWell (Phoenix, AZ)
- …of three to five years directly applicable experience preferred + Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice coding and documentation in value… more
- CenterWell (Seneca, SC)
- …of three to five years directly applicable experience preferred + Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice coding and documentation in… more
- Community Health Systems (Franklin, TN)
- …goals. + Support annual regulatory reporting submission requirements related to Medicare Quality programs (CQM, eCQM, MIPS, etc.) through coordination ... and value-based quality programs. This includes but is not limited to Medicare Traditional and Advantage , Commercial, governmental, ACO, BPCI, CJR, and other… more
- WellSpan Health (York, PA)
- …**General Summary** Provides staff/professional development expertise as an educator, consultant , facilitator, change agent and leader. Supports the development of ... **Common Expectations:** + Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards. +… more
- Deloitte (Los Angeles, CA)
- Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk and ... for this role ends on Feb 28, 2026 Work you'll do As a Senior Consultant in our Regulatory, Risk, & Forensic Healthcare Practice, you will have the opportunity to… more
- Brockton Hospital (Brockton, MA)
- Signature Healthcare is Southeastern Massachusetts' premier local provider of quality , personalized medical services. We are comprised of the award-winning ... should be: medical professionals across many locations communicating and collaborating, taking advantage of technologies and resources to make a difference in the… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …+ Legal Department: + Medical Directors + Member Appeals Grievance Programs (Commercial, Medicare Advantage , and InterPlan Program) + Physician Review Units + ... The Role:The Peer Review Specialist is responsible for monitoring the quality of the credentialed practitioner/ organizational provider networks ensuring our members… more
- Trinity Health (Boise, ID)
- …improvement role preferred. + Knowledge of NCQA and HEDIS standards and Medicare Advantage Star ratings gained through experience strongly desired. + ... as a key member of the Saint Alphonsus Health Alliance (Alliance) Quality and Performance Improvement team. This position works collaboratively with internal (ie… more
- ChenMed (Atlanta, 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 ... acts as a health coach, rather than just a consultant for sickness, by helping patients set short and...compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as… 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 ... acts as a health coach, rather than just a consultant for sickness, by helping patients set short and...compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as… more
- ChenMed (Miami, FL)
- …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 ... acts as a health coach, rather than just a consultant for sickness, by helping patients set short and...compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as… more
- ChenMed (Orlando, FL)
- …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 ... **Coaching for health** : Act as a health coach, rather than just a consultant for sickness, by helping patients set short and long-term health goals, partners with… more
- Provider Solutions & Development (Walla Walla, WA)
- …southeast Washington. A Level III trauma center, Providence St. Mary has a five-star quality rating from the Centers for Medicare and Medicaid Services. With its ... a large research network, and opportunities for investigator-initiated trials. Take advantage of all these professional growth opportunities while enjoying life in… more
- ChenMed (Berwyn, 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 ... acts as a health coach, rather than just a consultant for sickness, by helping patients set short and...compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as… more
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