- Merck & Co. (North Wales, PA)
- …patient access programs, while providing expertise on pharmacy, payer, and program administrator operations to drive quicker, compliant decision-making.-Provide ... stakeholders, and partner effectively across Marketing, Legal, Compliance, Sales, and Operations .-Project Management :- Expertise in project management ,… more
- CVS Health (Boston, MA)
- …convenient and affordable. **Job Description Summary** The primary responsibility of the Medicare Part B Operations Coordinator is to support activities related ... claims to Third Party Insurers. **Position Summary:** As a Medicare Part B Operations Coordinator, you will...**Required Qualifications:** + 1+ years (retail pharmacy, PBM, account management ) + 1+ years of professional MS Office experience… more
- The Cigna Group (Bloomfield, CT)
- …+ Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for ... regular trainings and other collaborative meetings as appropriate. + Works with management team to achieve operational objectives and financial goals. + Supports… 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 ... II** Working under general supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and… more
- Highmark Health (Harrisburg, PA)
- …set by the Organization are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for ... is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue streams and...management **Preferred** + 7 years in a government program setting, managed care, primary care management … more
- Centene Corporation (Cheyenne, WY)
- …experience. Master's degree preferred. + 5+ years project implementation, product or program management experience. + Medicare Supplement Benefits (Dental, ... objectives + Provide functional and technical knowledge regarding overall program requirements and operations **Education/Experience:** + Bachelor's degree… more
- USAA (Tampa, FL)
- …that will support Medicare Supplement Claims for USAA Life Company Claims Operations . This employee will report to the Life Company Chief Claims & Fraud Officer ... implementation of business processes. This role will involve execution of any Issue Management matters for Medicare Supplement claim issues. As business process… more
- Providence (OR)
- …Registered Nurse License in Washington State + Medicare : Insurance business operations experience + Case Management Experience (EX. Triage and Referral, ... empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare who will:** +...and or chronic conditions + Provide care coordination, case management and care management services to Providence… more
- Elevance Health (Atlanta, GA)
- …required. **Preferred Skills, Capabilities and Experiences** + Knowledge and understanding of Medicare rules and regulations for program areas including but not ... design, develop and lead activities to ensure an effective Compliance program . + Oversees programs for multiple departments/functions with numerous stakeholders and… more
- The Cigna Group (Bloomfield, CT)
- …the analytics strategy for Cigna Healthcare, performing research and analysis within the Medicare Stars program with a focus on HEDIS Stars measures. This ... reporting and dashboards focusing on HEDIS measures within the Medicare Stars program using a broad array...accuracy + Work experience as a Data Analyst in Medicare Stars, specifically in operations and reporting… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- … Part D and/or EGWP programs.** **Scope of Responsibilities:** Provides oversight and management of Medicare Part D/EGWP program . **Job Summary:** The ... and payment, reconciliation, and quality control. Coordination with Plan Sponsor to ensure program is compliant with Medicare Part D standards and consistent… more
- Elevance Health (Columbus, OH)
- …deliver member-centered, lasting pharmacy care. In this pivotal role on our CarelonRx Medicare Sales and Account Management team, the Pharmacy Account Director ... will make an impact: + Handling a variety of Medicare pharmacy accounts. + Utilizing strong account management...it poses on the pharmacy. -Understanding of the M3P program which influences drug affordability for Medicare … more
- CVS Health (Hartford, CT)
- …process. - Raising issues to Coverage Determination Clinical Pharmacists and Management team as needed. - Reading, analyzing, and interpreting general business ... Determination & Appeals experience. - 1 plus year of Medicare PART B experience - MHK, RxClaim, and People...for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed… more
- Point32Health (Canton, MA)
- …and timelines. The Senior Manager works closely with claims, membership operations , clinical services, care management , customer relations, sales, marketing, ... annual bid/rate and related filings, new benefit implementation, and product/vendor management processes. The Senior Manager will support annual assessment of new… more
- The Cigna Group (Bloomfield, CT)
- …will be responsible for leading the analytics strategy for Cigna Healthcare within the Medicare Stars program with a focus on Part D measures. This position ... limited to pharmacy, clinical, customer experience, product development and operations as needed. The person chosen for this role...developing advanced Stars reporting and dashboards related to the Medicare Stars program focused on Part D… more
- HUB International (Cincinnati, OH)
- …full-service global insurance broker and financial services firm providing risk management , insurance, employee benefits, Medicare & individual health, ... position is to provide a training ground and an understanding of the Medicare and Individual Health insurance industry: you will be supporting our experienced team… more
- Somatus (Mclean, VA)
- …and external vendors to execute MRA strategy. + Coordinate with the provider Network Management and the Quality Program to implement tactics for risk adjustment ... well-being + Community engagement opportunities + And more! The Sr. Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation of… more
- The Cigna Group (Sunrise, FL)
- …conduit to the providers and the individual that represents Cigna Medicare Advantage. The Provider Performance Enablement Lead Analyst's responsibilities include: + ... tools; effective communication to inform external partners. + Supporting the development, management and oversight of the physician/ provider network in the assigned… more
- The Cigna Group (Nashville, TN)
- …& procedures, marketing guidelines and broker engagement. . Coordinates effectively with Sales Operations team for lead management and sales functions . Create ... about the role:** **SUMMARY:** Responsible for the execution of the Cigna Medicare strategy for local topline sales agencies, directly contracted agents, and broker… more
- The Cigna Group (Denver, CO)
- …interface across multiple business areas, partnering with clinical leadership, care management operations , vendor clinical programs, and other departments as ... within the Clinical & Data Science Analytics team for Medicare Strategic Analytics. Reporting to the Manager of Care... Strategic Analytics. Reporting to the Manager of Care Management Analytics, the lead analyst will analyze healthcare claims… more
