- Molina Healthcare (Columbus, OH)
- **Job Description** **Job Summary** Molina Medicare Stars Sr Program Manager function supports program governance, plans, leads and implements quality ... initiatives to improve Star Ratings. * Serves as the Medicare Stars subject matter expert to Program Managers and in functional areas; leads programs to meet… more
- CVS Health (Columbus, OH)
- …with heart, each and every day. **Position Summary** Aetna is recruiting for a Senior Manager , Value Based Contractor who will partner with business development ... support segment leaders with growing focus on our Specialty Medicare Advantage and Medicaid VBC portfolio. **You will make...for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed… more
- CVS Health (Columbus, OH)
- …in a health plan, health system or provider organization + 3+ years of Medicare experience + Proven ability to interact with, influence and collaborate with internal ... for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed...includes an award target in the company's equity award program . Our people fuel our future. Our teams reflect… more
- CVS Health (Columbus, OH)
- …do it all with heart, each and every day. **Position Summary** As a Senior Investigator you will conduct high level, complex investigations of known or suspected ... and best course of action on investigations + Serves as back up to the manager as necessary + Cooperates with federal, state, and local law enforcement agencies in… more
- CenterWell (Columbus, OH)
- …part of our caring community and help us put health first** The Manager of Pre-Bill Audit provides strategic leadership and operational oversight for the ... in unbilled rates, revenue cycle performance, and compliance. The Manager leads a team of Pre-Bill Specialists, partners with... leads a team of Pre-Bill Specialists, partners with senior leadership, and champions initiatives that enable scale and… more
- Humana (Columbus, OH)
- …advanced agentic AI decision-making across our organization. As a Lead Technical Product Manager (PM-T), you will be responsible for shaping the vision, defining the ... and meets regulatory requirements. + Communicate complex technical concepts to senior executives in a clear, results-oriented manner. + Work with compliance… more
- CenterWell (Columbus, OH)
- …during the week.** + **Required to work every other holiday.** The **Care Manager , Telephonic Nurse** helps to ensure optimal continuity of care for patients ... appropriate. The Clinical Care Coordinator is under the general supervision of the Manager of Care Coordination and under established performance criteria. This is a… more
- CenterWell (Columbus, OH)
- …part of our caring community and help us put health first** The Program Management Lead, Offshore Coding Operations conducts quality assurance audits of medical ... records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Program … more
- CenterWell (Columbus, OH)
- …CenterWell Medical Group, a new virtual care delivery group within CenterWell Senior Primary Care, Humana's Primary Care Organization. This group will provide ... , a new virtual care delivery group within CenterWell Senior Primary Care, Humana's Primary Care Organization. This group...the state. . Graduate of accredited MD or DO program of accredited university . Board certification or eligible… more
- CenterWell (Columbus, OH)
- …+ Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare + Current nursing experience in Hospital, SNF, ... eligible dependents + Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities Travel:… more
- CenterWell (Columbus, OH)
- …is not guaranteed. There also may be opportunity to cover other aspect of the program , such as covering PTO for APPs in CenterWell Medical group (phase 1). There are ... **Knowledge of HEDIS measures and quality indicators** **Experience managing Medicare Advantage panel of patients with understanding of Best Practice… more