- Daiichi Sankyo, Inc. (Bernards, NJ)
- …but not limited to, areas of GPO/PBM and trade/distribution agreements, Medicare , Medicaid, product pricing, and government price reporting. Coordination with, and ... Lead drafting and negotiating contracts for commercial, Medicaid and Medicare coverage, as well as other government contracts, trade/distribution agreements,… more
- Highmark Health (Harrisburg, PA)
- …are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with ... STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the needs… more
- Banner Health (TX)
- …8:00 AM - 5:00 PM (AZ Time). In this position you will be monitoring Medicare Advantage Parts C & D operational control measures ensuring appropriate oversight is in ... is in place for accurate, complete, and compliant for Medicare Advantage Parts C & D. + Identifying and...a timely fashion. + Working in start-up environment + Medicare Advantage Compliance training, audits, regulations, and manuals. +… more
- Molina Healthcare (Columbus, OH)
- …analysis of markets and network initiatives. The Medical Economics Consultant manages conflicting priorities and multiple projects concurrently. Responsible for ... extracting, analyzing, and synthesizing data from various sources to identify risks and opportunities as well as packaging and delivering the results to senior leadership. Responsible for consulting with network and clinical management on opportunities to… more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Performance Improvement Consultant , you will be responsible for: + Serving as a Subject Matter Expert (SME) ... offered by the health plan + Act as a consultant and partner to the contracted IPAs + Traveling...experience * Knowledge of HIPAA regulations * Knowledge of Medicare Advantage, STARS/HEDIS program, and NCQA technical specifications, a… more
- Molina Healthcare (Columbus, OH)
- …application of Lean/Six-Sigma. + Project management. + Process design & engineering. + Medicare . + Proven track record with results. + Process mapping tools - Visio, ... MS Project. + Power BI or Tableau. **Preferred License, Certification, Association** Lean Six Sigma Master Black Belt or Lean Sensei To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job… more
- Guidehouse (Hanover, MD)
- …technical competency, business development, client service and people development. As a Consultant , you will work with an experienced team to support the development ... of client deliverables, internal and client presentations, day-to-day project logistics, and any additional project tasks. This position provides individuals the opportunity to serve clients across a wide variety of functions including strategy, process… more
- Elevance Health (Columbus, OH)
- ** Medicare Medical Director** Location: This position will work a hybrid model (remote and office). The ideal candidate will must live within 50 miles of one of our ... be able to work Eastern Time Zone hours. The ** Medicare Medical Director** is responsible for the administration of...discuss review determinations. + Serves as a resource and consultant to other areas of the company. + May… more
- VNS Health (Manhattan, NY)
- …analysis and interpretation designed to improve clinical outcomes. . Serves as consultant for unusual and difficult medical cases. Participates in the QARR/HEDIS ... Investigation Unit on issues related to Fraud, Waste, and Abuse of Medicare /Medicaid services.* Collaborates with pharmacy services to review PBM activities and… more
- AccentCare, Inc. (Columbia, MD)
- …84,000-105,000 + bonus and commission Offer Based on Years of Experience Hospice Care Consultant Hospice Care Consultant Hospice Care Consultant Hospice Care ... Consultant Hospice Care Consultant Hospice Care Consultant Hospice Care Consultant Hospice Care ...of referral patterns. Experience with, or willing to learn, Medicare regulations and related reimbursement practices related to hospice… more
- Humana (Columbus, OH)
- …on Medicare Advantage strategy development. As a Insurance Strategy Consultant , you will deconstruct issues and challenges, perform targeted research and ... organizations in the country. The Healthcare Strategy team supports Humana's Medicare and Medicaid business unit. This business unit, Humana's largest, comprises… more
- MyFlorida (Tallahassee, FL)
- 68064777 - HEALTH SERVICES & FACILITIES CONSULTANT Date: Jan 6, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... Care Administration Working Title: 68064777 - HEALTH SERVICES & FACILITIES CONSULTANT Pay Plan: Career Service Position Number: 68064777 Salary: $1,794.92 Biweekly… more
- CVS Health (Austin, TX)
- …schedule is Monday through Friday, 11:45am to 8:15pm Eastern Time.** The WorkLife Consultant (WLC) is part of the WorkLife Team and provides education about ... community resources, resource needs assessment, and community and/or national referrals to a variety of customers for a variety of needs including childcare, elder/adult care, and basic/everyday needs. The WLC is responsible for providing Worklife consultation… more
- CVS Health (Austin, TX)
- …Training hours may differ from the shift you are hired for. The WorkLife Consultant (WLC) is part of the WorkLife Team and provides consultation, assessment, and ... resource referrals to a variety of customers for a variety of needs including child care, elder/adult care, and basic/everyday needs. The WLC is responsible for providing Worklife consultation and informational services to members and plan sponsors. The most… more
- University of Washington (Seattle, WA)
- …**The Benefits Office has an outstanding opportunity for an HR Junior Benefits Consultant .** As part of the HR Benefits, Analytics & Information team, this ... exercising best benefits practices. **DUTIES AND RESPONSIBILITIES** The Junior Benefits Consultant will advise and counsel UW employees by generating required… more
- HealthEdge Software Inc (Columbus, OH)
- **Overview** **Overview:** The Business Consultant leads and mentors the Service Delivery team in all Tier 1 (Basic) and Tier 2 (Intermediate) consulting ... Source products (from basic to advanced features/functionality), payment methodologies/policies ( Medicare , Medicaid, and commercial), payment integrity, and healthcare plan… more
- Adecco US, Inc. (Bradenton, FL)
- …passionate professional to join our client's team! Position Name: **Membership Consultant ** Location: **Bradenton, FL** - 34209 Employment Type: Direct-Hire & ... - Monday-Friday: 8am-5pm - No: weekends **Requirements** - Several years of Medicare Sales and Community Relations experience. - Experience with Medicare … more
- Medical Mutual of Ohio (Brooklyn, OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. We are seeking an ... and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind… more
- Robert Half (Boston, MA)
- JOB REQUISITION Risk and Compliance - Healthcare Industry, Senior Consultant 2 LOCATION BOSTON ADDITIONAL LOCATION(S) NEW YORK CITY, SAN FRANCISCO, SEATTLE JOB ... Protiviti is looking for a Risk and Compliance Senior Consultant to join our growing Healthcare team. What You...healthcare payer regulations and guidance with emphasis on the Medicare Managed Care Manual. + Expertise of core business… more
- Stantec (Chandler, AZ)
- Benefits Consultant - ( 240004CC ) **Description** Grow with the best. Join a smart, creative, and inspired team that works to support operational excellence. The ... making our Company stronger. **Your Opportunity** We are looking for a Benefits Consultant specializing in compliance to join our HR Talent Services team! The… more
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