- Cleveland Clinic (Cleveland, OH)
- Director Medicare Coverage Analysis Join Cleveland Clinic's Main Campus where research and surgery are advanced, technology is leading-edge, patient care is ... the institutes and research billing office to create a Medicare coverage analysis billing grid for research studies with...and operate all administrative functions performed by the research Medicare coverage analysis team. + Serve as the subject… more
- CVS Health (New Albany, OH)
- …is compliantly and effectively operating in the market. As such, the Lead Director of Medicare Operations supports MAPD and SNP initiatives and implements ... personal, convenient and affordable. **Position Summary** In support of the Chief Medicare Officer, the candidate has responsibility for ensuring that the local … more
- CVS Health (Hartford, CT)
- …make health care more personal, convenient and affordable. **Position Summary** As the Medicare Reporting Lead Director , you will be responsible for the ... of monthly, quarterly, and annual financial results for the Medicare segment. This role will allow you to own...role will allow you to own the creation of Medicare consolidated financial materials during the forecasting & planning… more
- CVS Health (Salem, OR)
- …remote based (work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals: * Direct daily work on ... providers). * Provide direct support to appeal nurses and dedicated Medicare part D pharmacists; supervision and participation in the Second Look… more
- Humana (Columbus, OH)
- …or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical interpretation ... community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests...an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).… more
- Elevance Health (Wallingford, CT)
- ** Medicare Star Strategy & Program Development Director ** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will ... our Elevance Health PulsePoint locations. The **Strategy & Program Development Director ** is responsible for responsible for coordinating the relationship and… more
- Molina Healthcare (NY)
- …regulatory requirements. **Job Duties** + Under the leadership of the VP Medicare Segment Lead, this role will facilitate transparent and compliant execution of ... Medicare performance objectives. + Coordinates accountabilities between segment and...mitigate risk and develop/implement improvements across areas that impact Medicare performance. + Collaborates across Medicare segment,… more
- Molina Healthcare (San Bernardino, CA)
- …improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare , ... relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. + Experience demonstrating… more
- Healthfirst (NY)
- **Duties & Responsibilities:** + Develops, refines, and executes Medicare telesales strategy, including partnership with Dial America and across the various sales ... areas (eg, Analytics, Development, etc.) and stakeholders within the Medicare Sales team to define and implement enhancements to...VP in the development and management of the annual Medicare tele sales operating budget + Partners with Legal,… more
- Banner Health (AZ)
- …a direct interface with the Arizona Medicaid Agency (AHCCCS), Center of Medicare and Medicaid Services (CMS), Association for Community Affiliated Plans (ACAP), and ... the Arizona Association of Health Plans (AzAHP). CORE FUNCTIONS 1. Serves as the primary advisor to meet organization goals and objectives and has full budgetary accountability 2. Sets the department budget to meet organization goals and objectives and has… more
- UCLA Health (Los Angeles, CA)
- …of the Medicare Advantage Risk Adjustment leadership team, the Assistant Director of Risk Adjustment is instrumental in participating in the planning with the ... director and other functional areas for implementation and execution...and the manager of coding and education. The Assistant Director of Risk Adjustment will oversee the manager of… more
- CVS Health (Blue Bell, PA)
- …skills and attention to detail **Preferred Qualifications** + Previous Pharmacy or Medicare Part D experience + FSA designation + Experience with SAS, SQL, ... R, Python + Experience working with cross-functional partners to develop and align on strategic direction + Experience preparing exhibits and narratives for executive audiences **Education** + Bachelors' degree or equivalent experience **Pay Range** The… more
- Centers Plan for Healthy Living (Staten Island, NY)
- … Medicare or Sales experience SCOPE INFORMATION # Direct Reports: Director of Medicare Marketing Physical Requirements: The physical requirements described ... Medicare MAP Advisor 75 Vanderbilt Ave, Staten Island, NY...they need for healthy living. JOB SUMMARY : The Medicare MAP Advisor- Will promote and sale MAP and … more
- Corewell Health (Grand Rapids, MI)
- …+ Ensure compliance to CMS requirements and standards + Other projects assigned by Medicare Quality Manager and/or Director How Corewell Health cares for you + ... Job Summary The Medicare Quality Specialist, Pharmacy will assist the Medicare Adherence Pharmacists Team to improve Medicare Star Ratings and CAHPS by… more
- CVS Health (Sacramento, CA)
- … Director UM decisions. If specifically assigned to one business segment (ie, Medicare clients), each director will become sufficiently skilled in various UM ... UM decisions. If specifically assigned to one business segment (ie, Medicare clients), each director will become sufficiently skilled in various UM programs to… more
- CVS Health (Hartford, CT)
- …in new and exciting ways every day. Aetna is recruiting for an Executive Director , Sales & Account Management for Aetna's Medicare Senior Supplemental Insurance ... of the sales team. This pivotal role drives growth across Medicare Supplement and Ancillary products through National Marketing Organizations (NMOs), strategic… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The Corporate Medical ... Director works on problems of diverse scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… more
- Molina Healthcare (UT)
- …**Job Summary** Provides new and existing members with the best possible service in relation to billing inquiries, service requests, suggestions and complaints. ... Resolves member inquiries and complaints fairly and effectively. Provides product and service information to members, and identifies opportunities to maintain and increase member relationships. Recommends and implements programs to support member needs… more
- Centers Plan for Healthy Living (Bronx, NY)
- … Medicare or Sales experience SCOPE INFORMATION # Direct Reports: Director of Medicare Marketing PHYSICAL REQUIREMENTS: The physical requirements described ... healthy living. JOB SUMMARY : The Licensed Benefits Advisor- Medicare Sales, Maintains relationships, services our existing customers and...in a manner that is compliant with Center for Medicare and Medicaid Services (CMS) and company policies and… more
- Brookdale Senior Living (Houston, TX)
- …other team members to establish appropriate level of care in accordance with Medicare /Medicaid reimbursement levels. + Assists the Director , Clinical Services in ... been with us for at least a year. Responsibilities Assists the Director , Clinical Services in planning, organizing, developing and directing the day-to-day… more
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