- UCLA Health (Los Angeles, CA)
- …level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team of ... UM coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and manage various...degree required + Five or more years of utilization management required + Four or more years of managerial… more
- GEHA (Lee's Summit, MO)
- …a personalized customer experience, sustained by a nimble and efficient organization. The Medicare Part D Performance Management Specialist will report to the ... Serves as a subject matter expert to Centers for Medicare & Medicaid Services ( CMS ) Part D...Monitor key performance indicators in clinical, operational, and vendor management areas to proactively inform leadership and departmental business… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …the product development of the Medicare Advantage. This role supports Medicare product management by evaluating data trend experience, creating data ... self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans....work on product and benefit design during the annual CMS Bid cycle and act as a key member… more
- USAA (San Antonio, TX)
- …implementation of business processes. This role will involve execution of any Issue Management matters for Medicare Supplement claim issues. As business process ... + 5 or more years of experience working with Medicare Supplement and Medicare product management...of process, procedures and requirements related to Centers for Medicare & Medicare Services ( CMS )… more
- Healthfirst (NY)
- … and organization change management + Experience using an enterprise project management system such as MS Project Server and MS Project **Preferred ... implementations or upgrades + Experience using an enterprise project management system such as MS Project Server...Knowledgeable of Department of Health (DOH) and Center for Medicare & Medicaid Services ( CMS ) regulations **Compliance… more
- UCLA Health (Los Angeles, CA)
- …, and incident management . Leveraging your deep knowledge of CMS Medicare Advantage and DMHC insurance regulations, you'll implement industry-leading ... regulatory submissions, and risk management . + Ensure adherence to CMS Medicare Advantage and DMHC insurance regulations through the application of best… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …ProAct. Responsibility for the understanding and compliance of benefit designs, system management of formularies, eligibility, claims and payment, ... and/or EGWP programs.** **Scope of Responsibilities:** Provides oversight and management of Medicare Part D/EGWP program. **Job...Medicare Part D/EGWP programs + Ensure compliance with CMS rules and regulations surrounding Medicare Part… more
- Centene Corporation (Cheyenne, WY)
- …Master's degree preferred. + 5+ years project implementation, product or program management experience. + Medicare Supplement Benefits (Dental, Vision, Hearing) ... levels, and value by leading the dental, vision and hearing Medicare Product development through strategy development, identify opportunities, plan, organize,… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …+ Oversee Medicare Market project management resources and ensure management of all Medicare Management corporate IT projects, including meeting ... strategy to meet market needs. Key Accountabilities: + Direct Medicare Product strategy and portfolio management to...local Division of Insurance (DOI), and the Centers for Medicare and Medicaid Services ( CMS ) + Ensure… more
- Healthfirst (NY)
- … products in various forms and functions + Acts as a key member of the Medicare Management Team, with a strong dotted line reporting to SVP of Medicare ... forecasts + Works closely with actuarial team and product management team to support the annual bid process +... product and market dynamics + Strong understanding of CMS rules and policies impacting Medicare product… more
- Kelsey-Seybold Clinic (Houston, TX)
- …associated professional claims. Essential job functions include: Apply knowledge of Centers for Medicare & Medicaid Services ( CMS ) rules specific to DRG pricing ... methods, APC, Outpatient Prospective payment system mechanics (OPPS) and Contractual Payment Rates. Position will...analysis of high dollar claims and present summary to management . **Job Title: Medicare Claims Analyst** **Location:… more
- The Cigna Group (Bloomfield, CT)
- …or national ancillary account management environment. + Experience with Medicare Advantage - Supplemental Benefits, CMS guidelines, FDR Operations, Clinical ... This is a ** Medicare Advantage position** WORK LOCATION: REMOTE position The...market intelligence to inform strategy. + Provides oversight and management to assigned Book of Business (BoB) from implementation… more
- The Cigna Group (Bloomfield, CT)
- …required; MBA and/or Masters in relevant field also valued + **2+ years Medicare experience, required** + **2+ years Project Management experience, required** + ... is REMOTE** The **Project Manager** is a key role that supports **Cigna's Medicare Advantage** line of business, directly addressing customer and client demands for… more
- UCLA Health (Los Angeles, CA)
- …billing or encounters project is required + Minimum of 5 years' experience with CMS processes in a Medicare or Managed Care environment required + Project ... a key leadership role within a world-class, award-winning health system . Support positive patient experiences. Take your career in...at UCLA Health. As a key member of our Medicare Advantage Operations team, you will partner with business… more
- UCLA Health (Los Angeles, CA)
- …or more years of clinical practice experience + 2 years or more years of Medicare Advantage management experience + Experience in a health plan or large ... of care and cost-effectiveness + Manage utilization and case management activities to drive efficiency and quality + Oversee...healthcare organization, preferred + Strong knowledge of Medicare regulations and CMS guidelines + Excellent… more
- The Cigna Group (Bloomfield, CT)
- …shifts with every other weekend (Tuesday ALT Day).** + Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part ... of final determination of the appeals using the appropriate system applications, templates, communication process, etc. + Communicate appeal information… more
- State of Georgia (Baldwin, GA)
- …current standings and daily work. . Required to understand and utilize PECOS (online Medicare enrollment management system ) . Update each providers CAQH ... on NPPES and CMS databases. . Maintaining licenses for Medicaid and Medicare information. . Knowledge of how to utilize and understand GAMMIS. . Maintain… more
- Medical Mutual of Ohio (OH)
- …reply report review and validating manufacturer labeler code updates in the PBM system . . Supports Medicare Plan Finder processes for validating DestinationRx ... a health plan, pharmacy, or PBM operations, which includes exposure to Centers for Medicare & Medicaid Services ( CMS ) guidelines, preferably Part D. . Certified… more
- Elevance Health (Smithfield, RI)
- … Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services ( CMS ) division of the Department of Health ... **Audit & Reimbursement Senior -** ** Medicare Cost Report Audit** **Locations:** _This is a...and audits. + Review of complex exception requests and CMS change requests. + Perform supervisory review of workload… more
- CareOregon (Portland, OR)
- … Encounter Data Analyst leads the process for the end-to-end Encounter Data Processing System (EDPS) data flow and works within CMS guidelines for acceptable ... the complete and accurate submission of encounter data to CMS . + Monitor and track Medicare encounter...file reconciliations. + Minimum 3 years' healthcare, claims, data management , EDI experience Preferred + Experience with Medicare… more