- 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
- 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
- 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
- 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
- The Cigna Group (Bloomfield, CT)
- …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
- CVS Health (Hartford, CT)
- …accountable for achieving financial and performance targets as well as Commercial/ Medicare /Medicaid Scoreable Action Item (SAI) Management . Performance is ... unrivaled presence in local communities and their pharmacy benefits management capabilities, we're joining members on their path to...every day. Aetna is recruiting for an AVP, Business Operations who is responsible for developing Medical Policy &… more
- The Cigna Group (Bloomfield, CT)
- **The Marketing Operations Advisor (Campaign Engagement Strategist) is responsible for execution, monitoring and measurement of all the engagement campaigns across ... degree in marketing, communications, or a related field preferred + Medicare , Medicaid & Marketplace communication guidelines + Proven experience in developing… more
- The Cigna Group (Bloomfield, CT)
- …a team of Senior Advisors and Advisors responsible for the development and management of the Medicare Prescription Payment Plan (M3P) product. This individual ... products, broad-based knowledge of Regulated Markets/Pharmacy Benefit Manager (PBM) operations , experience leading people, a strategic mindset, and the ability… more
- CVS Health (Hartford, CT)
- …United States. In this role as Medical Director MPO (Medical Policy & Operations ) you will be responsible for providing clinical expertise and business direction in ... support of medical management programs to promote the delivery of high quality,...and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject matter expertise… more
- Fallon Health (Springfield, MA)
- …experience, service, and clinical quality. Fallon Health's Summit ElderCare(R) is a Program of All-Inclusive Care for the Elderly-PACE for short. PACE, an ... alternative to nursing home care, is a program that helps people 55 and older continue living...be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief summary… more
- Humana (Hartford, CT)
- …Technology, Enrollment, Member Services, Grievance and Appeals, Claims, Encounters, Program Integrity and Subcontractor Management . Key Responsibilities include: ... to improving the health of the communities it serves. The **Medicaid Capture Management ** team's purpose is to successfully position Humana to enter new markets… more
- Humana (Hartford, CT)
- …and help us put health first** Humana Healthy Horizons is seeking a Program & Process Design Advisor who provides data-based strategic direction to identify and ... address business issues and opportunities. The Program & Process Design Advisor will support the New Medicaid State Implementations and lead teams to analyze complex… more
- The Cigna Group (Bloomfield, CT)
- …understanding of CMS Interoperability, FHIR Implementation Guides and Standards, and data management specific to Medicare along with focuses on respective ... Guides and Standards + Analyze the compliance and Interoperability Program use cases and create FHIR mapping templates +...+ Provides linkage and continuity to business units, development, operations and technical support groups in the testing and… more
- Humana (Hartford, CT)
- …us put health first** The COS - Market Leadership Advisor manages the development, operations , and results of a health plan. The Market Leadership Advisor works on ... Ensures that assigned health plans are meeting or exceeding corporate Medicare performance benchmarks and implementing the strategic plan. Maintains relationships… more
- Prime Therapeutics (Hartford, CT)
- …of Medicare Part D, Medicaid, state healthcare product or program related regulations and/or Health Insurance Marketplace guidance + Experience identifying ... successful execution of key components and elements of Prime's corporate compliance program . This position works closely with designated business areas, legal, and… more
- Humana (Hartford, CT)
- …not profit organization) or has several years' experience with stakeholder management (strategy/ operations at a top-tier consulting/professional services firm). ... also will be effective at multitasking and possess keen program and change management skills to balance...driving Humana's long-term vision to achieve leading growth in Medicare and individual products. The MarketPoint strategy team was… more
- Hartford HealthCare (Hartford, CT)
- …Lexis, Westlaw & other research tools, as well as technology used in operations , such as contract and document management * Strong analytical, inter-personal, ... system, an array of senior care services, a mobile neighborhood health program and a comprehensive physical therapy and rehabilitation network. On average, Hartford… more
- Prime Therapeutics (Hartford, CT)
- …efficient in using standard software. + Knowledge of system process analysis and/or program management , estimating IT system development and testing. + For ... hoc requests for support, reports and analysis. Supports departmental management team by providing trending and performance data. Supports...Medicare , requires 5+ years of experience working in Medicare Operations . + Minimum of 4 years… more
- Bristol Myers Squibb (Hartford, CT)
- …Account Management Team, Payer Account Executives, Cell Therapy Patient Operations , Cell Therapy Patient Support Services, Cell Therapy Access Strategy Team, and ... provide relevant regional marketplace feedback in a timely manner to management on customer business trends, competitive updates and account issues/opportunities +… more
- Prime Therapeutics (Hartford, CT)
- …monitor aspects of compliance and validate policies, procedures, licensure, and program manuals are effectively followed and/or maintained. Works independently to ... the organization to validate regulatory requirements are met and that business operations are aligned with expectations of applicable regulatory guidance + Develop… more