- UCLA Health (Los Angeles, CA)
- Description We're seeking a strategic Senior Product Manager to lead the design, development, and implementation of our Medicare Advantage products. In this ... role, you'll partner with the Director of Medicare Product Development and Bids to guide the annual bid process, drive cross-functional initiatives, and ensure… more
- Geisinger (Danville, PA)
- Job Summary We are seeking a detail-oriented professional with expertise in Medicare and Pennsylvania Medicaid cost reporting to join our team. The ideal ... candidate will have a strong understanding of Medicare settlement processes, compliance requirements, and hospital...dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of… more
- Humana (Sanford, FL)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...Sales Agents, you'll work under the guidance of a Senior Manager and Regional Director who are committed to… more
- BrightSpring Health Services (Bowling Green, KY)
- …Sales Account Representative/Executive for our Abilis Health Plan who will work with senior care partners to assist in enrolling new residents and members. You will ... actively market our plan to new senior care partners within a plan service area. Regional...the plan and providing high quality customer service, providing professional , accurate and timely response to all inquiries regarding… more
- Fallon Health (Springfield, MA)
- …NaviCare program. + Participates in all community outreach activities, such as senior fairs, community events, and elder services professional association events ... area, and who have MassHealth Standard, and may have Medicare . It combines MassHealth (Medicaid) and Medicare ...be made to tactical plans. + Manages their own professional development by seeking advice, training, and coaching from… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... SLA's. With speed, accuracy, and integrity, ensures that enrollee data for Medicare Advantage, Medicare Supplement, NaviCare, Summit Elder Care, Fallon Health… more
- Molina Healthcare (IA)
- …functional field of knowledge although they may have technical team members. Senior Program Management professional . Responsible for overall governance across ... needs + Escalates gaps and barriers in implementation and compliance to AVP, VP and senior management...implementation and compliance to AVP, VP and senior management + Consultative role, develops business case methodologies… more
- Point32Health (Canton, MA)
- …about who we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Senior Manager, Compliance Program will manage the day-to-day operations ... and direct administration of activities, projects, and personnel necessary to ensure compliance with Medicare , Commercial and Medicaid laws and regulations and… more
- Mount Sinai Health System (New York, NY)
- …and Ancillary Contracts across the Mount Sinai Health System. MSHP seeks a Senior Contract Compliance ( Professional Billing) Analyst who will primarily ... compliance related to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team...be responsible for tracking, trending, and analyzing professional billing (PB) contract compliance issues. This… more
- Humana (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Senior Quality Compliance Professional is an integral part of the Michigan Quality ... projects. The role operates as a subject matter expert in Quality Compliance . POSITION RESPONSIBILITIES: + Involved in studies as required by the External… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …states (ME, NH, VT, MA, RI, CT)** Reporting to the Director of Billing Compliance , the Senior Billing Compliance Reviewer ensures the integrity, accuracy, ... regulatory compliance of Dana-Farber Cancer Institute's hospital and professional billing through data-driven audits and targeted monitoring. This role conducts… more
- Prime Therapeutics (Columbia, SC)
- …career? Come build the future of pharmacy with us. **Job Posting Title** Senior Compliance Analyst (Regulatory Change Management) - Remote **Job Description** ... The Senior Compliance Analyst assists in the implementation...and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC) + Certified Project Management… more
- Prime Therapeutics (Little Rock, AR)
- …a purpose-driven career? Come build the future of pharmacy with us. **Job Posting Title** Senior Compliance Analyst - Remote **Job Description** The Senior ... Compliance and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC) + Certified Project Management Professional (PMP)… more
- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** As a Senior Network Performance Professional at Humana, you will play a pivotal role in ... and overall performance through strategic initiatives and strong relationship-building. As a Senior Network Performance Professional at Humana, you will play a… more
- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent and ... abusive practices. The Senior Fraud and Waste Professional work assignments...Knowledge of healthcare payment methodologies + Proven knowledge in Medicare regulations + Strong organizational, interpersonal, and communication skills… more
- Humana (Dunedin, FL)
- …remote with travel to provider offices within region The Quality Improvement Senior Clinical Professional (RN) is responsible for the development, implementation ... and management oversight of the company's Medicare Stars Program in the West Coast Tampa region...(Clearwater, St. Petersburg, Palm Harbor, Dunedin) The Quality Improvement Senior Clinical Professional (RN) develops programs designed… more
- Humana (Columbia, SC)
- …a part of our caring community and help us put health first** The Senior Configuration Professional work focuses on accessing and configuring an application or ... building modules, developing tables/reports, and creating complex functions. The Senior Configuration Professional work assignments involve moderately complex… more
- Humana (Olympia, WA)
- **Become a part of our caring community and help us put health first** As a Senior Network Performance Professional at Humana, you will play a pivotal role in ... related field, or equivalent work experience. + Experience with Medicare Risk Adjustment and/or medical coding. + Experience with...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (South Bend, IN)
- …Dual Eligibility Special Needs Plan (HIDE SNP) in Michigan is seeking a Senior Consumer Experience Professional who will ensure optimized interaction between ... Humana and our members. The Senior Consumer Experience Professional will work assignments...Care and/or Service Coordination team feedback, market or regulatory compliance information, Grievance and Appeal information, call listening, member… more
- Humana (Raleigh, NC)
- …a part of our caring community and help us put health first** The Senior Technology Solutions Professional devises an effective strategy for executing and ... delivering on IT business initiatives. The Senior Technology Solutions Professional work assignments involve moderately complex to complex issues where the… more
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