- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. As a key member of our Medicare Advantage Operations team, you will partner with business and technical teams as ... of 5 years' experience with CMS processes in a Medicare or Managed Care environment required + Project... Medicare or Managed Care environment required + Project Management Professional certification is a plus + Experience… more
- The Cigna Group (Tampa, FL)
- …and translating changes into implementation plans (DFSS and DMAIC preferred) + Medicare Operations experience preferred. + Bachelors Degree strongly preferred, ... A member of the Cigna Medicare Business Operational Excellence Process Engineering team. This...+ Define the business case, guide chartering, apply proper project management techniques, collect customer feedback and convert to… more
- Banner Health (WA)
- …Banner Plans & Networks Team, where your data analysis skills, quality assurance, and Medicare Advantage experience will be vital. You will use your background ... in informatics, data science, and report building to help us excel in our Medicare reporting and performance objectives. You will lead projects that are essential to… more
- Medical Mutual of Ohio (Toledo, OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Medical Mutual' ... **_The Operations Data Analyst II position allows you the_**...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. Manages a ... corporate leadership. + 3 years' experience working with healthcare products/programs, preferably Medicare Advantage or government programs. + Proven ability to… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. **Responsibilities** ... Set (HEDIS) lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage , and Medicaid), including HEDIS audit submission, Consumer… more
- Martin's Point Health Care (Portland, ME)
- …most major insurance plans. Martin's Point also administers two health plans: Generations Advantage ( Medicare Advantage plans available throughout Maine and ... a "Great Place to Work" since 2015. Position Summary The Manager, Facility Operations and Capital Projects is responsible for the oversight of the internal… more
- The Cigna Group (Westerville, OH)
- This role is responsible for supporting Cigna Medicare Advantage risk adjustment prospective programs, solutions, and performance in aligned operational region ... Provider Performance Enablement teams, Provider Education, and the Risk Adjustment Operations teams. The Prospective Program Solutions & Performance Advisor works… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …with Marketing, Market Research, Sales, Operations , and Compliance + Oversee Medicare Market project management resources and ensure management of all ... bid process, Blue-to-Blue conversion (age-in) initiatives. Product portfolio includes: Direct Pay Medicare ( Medicare Advantage Prescription Drug Plan, … more
- Johns Hopkins University (Baltimore, MD)
- …improve performance in multiple pay for performance programs such as MD PCP and Medicare Advantage . + Develop and participate in the analysis and evaluation of ... We are seeking an **_Assistant Clinical Administrator, Ambulatory Operations & Patient Access_** to provide high level leadership and administrative oversight for,… more
- CVS Health (Woonsocket, RI)
- …clients in ACO REACH, Medicare Shared Savings Program (MSSP), and Medicare Advantage programs. We are model-agnostic, payer-agnostic focused on providing the ... expert will be a key part of securing partnerships with national and regional Medicare Advantage payors to enable risk-based contracts with the CVS Accountable… more
- Humana (Columbus, OH)
- …and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and/or Medicaid requirements, and will ... **Preferred Qualifications:** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
- Nucleusteq (AZ)
- …warehouse structures as well as owning data inflows and outflows that support the Medicare Advantage Risk Adjustment teams and efforts. * Design & Development, ... applications consistent with the established specifications and business requirements for the Medicare Advantage Risk Adjustment teams to deliver business value;… more
- Trinity Health (Canal Winchester, OH)
- …(https://www.mcmg.mountcarmelhealth.com/) , a college of nursing (https://www.mccn.edu/) , a Medicare Advantage plan (https://www.medigold.com/) , and extensive ... and addresses opportunities and barriers as they arise. 11. Provides regular project status updates to customers and leadership especially when there are delays… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. Medical Mutual' ... offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. Under general ... of new or revised medical policies used by clinical operations in performing clinical review function; drafts medical policies...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and… more
- American Institutes for Research (MA)
- …new business with CMS, AHRQ, or other HHS agencies. + Extensive knowledge of Medicare payment policy, Medicare Advantage , and/or Medicaid. + Knowledge of ... agencies, including but not limited to the Centers for Medicare and Medicaid Services (CMS). Candidates hired for the...legal compliance to its full integration in our strategy, operations , and work environment. At AIR, we define diversity… more
- Humana (Columbus, OH)
- …of experience with strategy execution from conception to implementation. + Experience with Medicare Advantage and Dual Special Needs Plans. + Financial and/or ... operational experience across Senior Primary Care, Medicare Advantage , Medicaid, Pharmacy, or Home. + Understands the build, measures, learns and tests… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. **Responsibilities** ... offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans… more
- Trinity Health (Columbus, OH)
- …**Shift:** **Description:** **Why MediGold?** MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and other ... health insurance industry specific to sales and marketing roles (related to Medicare Advantage or another government-related insurance line) + Experience… more