- The Cigna Group (Nashville, TN)
- **Summary** The Head of Medicare Technology Operations (MTO) Support is a results-oriented leader with demonstrated ability to build, lead, and inspire large ... teams to achieve success. The complexity of the Medicare industry demands exceptional leadership that is able to...uniquely positioned to work directly with engineering and business operations and partner to solve tactical and strategic problems.… more
- The Cigna Group (Bloomfield, CT)
- **Job Description** Medicare Technology Operations - Observability & Alerting Specialist **Overview** The Observability & Alerting Specialist is responsible for ... ensuring the reliability, availability, and performance of applications within the Medicare Technology Operations domain and the systems they interact with. They… more
- AmeriHealth Caritas (Newtown Square, PA)
- **Corporate Director, Population Health Clinical Operations , Medicare ** Location: Newtown Square, PA Primary Job Function: Medical Management ID**: 37990 **Job ... Management and the Chief Medical Officer, the Corporate Director, Population Health Medicare Clinical Operations is responsible for multiple line of business… more
- Elevance Health (Atlanta, GA)
- …**Preferred Skills, Capabilities and Experiences** + Knowledge and understanding of Medicare rules and regulations for program areas including but not limited ... Risk Adjustment Payment methodologies and the CMS HCC Model. + Healthcare operations and/or compliance experience within a large payor organization. + Progressive… more
- The Cigna Group (Bloomfield, CT)
- …goals, and service levels + Proficient knowledge of policies and procedures, Medicare , HIPPA and NCQA standards; + Professional demeanor and the ability to ... work effectively within a team or independently; + Flexible with the ability to shift priorities when required + Other duties as required **Qualifications:** + Current Licensed Practical Nurse LPN or Licensed Vocational Nurse LVN. + Active unrestricted license… more
- UCLA Health (Los Angeles, CA)
- …do all this and more at UCLA Health. As an important member of our Medicare Advantage Operations team, you will be instrumental in maintaining and running ... required * Five or more years of experience with CMS processes in a Medicare or managed care environment * Must have 3-5 years of experience with Encounter… more
- Molina Healthcare (NY)
- …+ 5-10 years' experience in Managed Care, specifically government programs and/or Medicare /Duals Health Plan Operations + Strong leadership in a matrixed ... regulatory requirements. **Job Duties** + Under the leadership of the VP Medicare Segment Lead, this role will facilitate transparent and compliant execution of… more
- Humana (Louisville, KY)
- …include: + Research, understand and apply laws, regulations, and regulatory guidance for DSNP Medicare Operations . Serve as the subject matter expert on DSNP ... Medicare Operations . + Develop audit methodology and perform auditing and monitoring activity to prevent and detect issues of noncompliance and provide guidance… more
- CVS Health (Carson City, NV)
- …Experience with Medicare Advantage, SSI or Medicaid product sales or operations . - Microsoft experience, specifically Excel and PowerPoint - Health & Life ... Las Vegas Nevada area** Aetna is looking for a Medicare Sales Broker Manager to join the Nevada sales...sales results through an assigned Nevada hierarchy of independent Medicare brokers. Responsibilities include: - Develop and execute market… more
- Point32Health (Canton, MA)
- …medical and other healthcare activities. + Strong subject matter expertise in Medicare and/or Medicaid Operations and Compliance Requirements + Demonstrated ... laws and regulations related to the Government Programs Compliance Programs for Medicare and Duals products. This role involves guiding teams and processes while… more
- VNS Health (Manhattan, NY)
- …regularly with internal departments, including but not limited to, Finance, Medicare Operations , Network Management, Provider Contracting, and Health Economics, ... OverviewSupports initiatives that will impact the Risk Adjustment programs and operations . Collaborates with internal departments and external vendors on risk… more
- Commonwealth Care Alliance (Boston, MA)
- …organizational skills + Excellent problem-solving ability + Thorough understanding of managed care/ Medicare plan operations preferred + Excellent knowledge of MS ... initiatives aimed at improving multiple domains of the health plan's operations , including claims, call center, enrollment, encounter management and billing,… more
- Elevance Health (Seven Fields, PA)
- …+ Ability to analyze and manipulate large and complex datasets. + Background in Medicare operations and/or financial reporting. + Exposure to provider or health ... risk adjustment and/or health insurance industry. + Experience in Medicare Advantage and Medicaid in a provider based or...plan operations . + Able to collaborate cross functionally with other… more
- Prime Therapeutics (Columbus, OH)
- …+ For positions supporting Medicare , requires experience working in Medicare Operations . **Work Experience** Work Experience - Required: Business Analysis ... Work Experience - Preferred: **Education** Education - Required: A Combination of Education and Work Experience May Be Considered., Bachelors Education - Preferred: **Certifications** Certifications - Required: Certifications - Preferred: Potential pay for… more
- CVS Health (Houston, TX)
- …regularly with internal departments, including but not limited to: Finance, Medicare Operations , Network Management, Provider Contracting, and Health Economics, ... + Knowledge of government-regulated healthcare programs such as Medicaid or Medicare + Healthcare experience or knowledge of health insurance concepts +… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …role responsible for client relationship or account management. * Experience in a Medicare Advantage healthcare operations environment working with Medicare ... innovative solutions to drive effective change. A subject matter expert in Medicare processes, the manager ensures services align with client goals and regulatory… more
- UCLA Health (Los Angeles, CA)
- …appeals, grievances, utilization management, or potential quality issues * Knowledge of Medicare Advantage plan operations and CMS regulations, highly desired * ... of medical care and services rendered in relation to Medicare guidelines, compliance requirements, and internal policies. + Identifying...of 2 years' experience in a managed care or Medicare Advantage setting is highly desired * Experience in… more
- CVS Health (Springfield, IL)
- … Operations . + Caremark Medical and Aetna Medical. + Medicaid PA & Appeals Operations . + Medicaid and Medicare Data Entry Operations for partially ... execution in achieving operational excellence and compliance for Clinical Government Services Operations (CGSO), to include, but not limited to: + Commercial &… more
- Medical Mutual of Ohio (OH)
- …I** Working under general supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and ... under general supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part...complex daily operations in compliance with the Medicare Part D (pharmacy) and Medicare Part… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Facilitates and supports ... the option to work remote; Ohio residents preferred._** **Responsibilities** ** Medicare Advantage Customer Experience Strategist** + **Facilitates projects to… more
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