- The Cigna Group (Bloomfield, CT)
- …or national ancillary account management environment. + Experience with Medicare Advantage, Cigna HealthSpring Operations and Supplemental programs + A ... The **National Ancillary & Non-par Management (NANPM) Senior Advisor** role is a critical...40% of Cigna's total medical cost savings. The **NANPM Medicare Senior Advisor** is responsible for negotiating Medicare… more
- The Cigna Group (Bloomfield, CT)
- …at least three (3) years direct experience with government sponsored health plans in operations or project management + Project Management experience and/or ... The Medicare Advantage Market Performance Advisor is cross-functional, collaborative...experience and information among teams and within the Performance Operations department. The Market Performance Advisor supports the development… 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
- Elevance Health (Wallingford, CT)
- …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
- The Cigna Group (Bloomfield, CT)
- This job posting encompasses two **Regional Medicare ** **Provider Contracting Senior Managers** serves as an integral member of the Network Development and Solutions ... Team, supporting the Northeast Region. This role reports to the Medicare Provider Contracting Regional Vice President. This role is a key contributor to the… more
- The Cigna Group (Bloomfield, CT)
- …of each element. The PDQA DG&O team will work with multiple stakeholders across Medicare operations , as defined by the Dedicated Medicare Operating Model ... **Essential Functions and Responsibilities** + Coordinate and partner with the key Medicare operations teams, including claims, enrollment, fulfillment, network … 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
- The Cigna Group (Bloomfield, CT)
- …with various departments including but not limited to: Finance, Risk Management , Operations , Contracting, Provider Relations, Health Services, Product, and ... the total medical cost analytics for the Government Business Segment (Primarily Medicare Advantage business). This role will be responsible for developing medical… 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
- Humana (Hartford, CT)
- …Horizons is seeking an Associate Director, Medicaid Implementation (Business Project Management ) to lead within a specific defined business area (non-IT) within ... in a traditional Project Manager functional way. Individuals with business process change management and project management are best suited for this role. The… more
- Humana (Hartford, CT)
- …it. The result is a better quality of life-not only for people with Medicare and Medicaid but also for families, military service personnel, and communities at ... health outcomes. The facts: * Over 35% of HUM's Medicare and Medicaid members have a BH diagnosis, including...metrics, with input from key stakeholdersSize opportunity for BH program advancement at HUMAssess key developments and trends in… more
- Fallon Health (Springfield, MA)
- …250 participants or less. **Responsibilities** **Primary Responsibilities:** + Coordinates all program services, activities and day-to-day operations of the PACE ... administrative activities relating to the Summit ElderCare site including fiscal management , program planning and development. Demonstrates innovative approach… 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
- 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)
- …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