- Molina Healthcare (Lincoln, NE)
- … Medicare Advantage product strategic plan. + Has oversight over Molina's Medicare Advantage operations as they relate to compliance, operations , ... **Job Summary** As the leader for Molina's Medicare Advantage product (Non-Dual), this position...this position has P&L, business strategy, sales distribution and provider network responsibility for all products, as well as… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As an important member of our Medicare Advantage Operations team, you will be instrumental in maintaining and ... required * Five or more years of experience with CMS processes in a Medicare or managed care environment * Must have 3-5 years of experience with Encounter… more
- Humana (Austin, TX)
- …communication across stakeholders. This role requires strong analytical skills, knowledge of Medicare Advantage market operations , and the ability to ... and execute strategic business initiatives. Key responsibilities include researching the Medicare Advantage market, analyzing trends, preparing detailed reports… more
- UCLA Health (Los Angeles, CA)
- …appeals, grievances, utilization management, or potential quality issues * Knowledge of Medicare Advantage plan operations and CMS regulations, highly ... Ensuring timely, accurate, and thorough review of member and provider complaints, working closely with clinical and administrative teams....of 2 years' experience in a managed care or Medicare Advantage setting is highly desired *… more
- UCLA Health (Los Angeles, CA)
- Description As a member of the Medicare Advantage Operations team, Business Data Analyst is instrumental in independently developing the detailed ... update training documentation + generate adhoc reports to support operations team as needed This is a flex-hybrid role...+ Minimum of five (5) years' experience in a Medicare or Managed Care environment managing enrollment, claims or… more
- Highmark Health (Harrisburg, PA)
- …are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with ... other functions in the provider area, data analytics, and key internal/external stake holders...HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to… more
- Medical Mutual of Ohio (OH)
- …group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans provide peace of mind to more ... self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and...and standard industry practices. Ability to identify gaps in operations processes, provide remediation, and hold applicable… more
- Centene Corporation (Jefferson City, MO)
- …advising management concerning state and federal legislation with a focus on Medicare Advantage and Prescription Drug plans, regulations and other requirements ... Counsel on projects and certain matters. **For Health Plan Operations and Medicare :** + Serves as legal...in good standing preferred **Preferred Criteria:** Inhouse experience with Medicare Advantage and Prescription Drug Plans and… more
- Medical Mutual of Ohio (OH)
- …group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans provide peace of mind to more ... I** Working under general supervision, administers standardized to moderately complex daily operations in compliance with the Medicare Part D (pharmacy) and… more
- CVS Health (Salt Lake City, UT)
- …of medical costs management, compliance, and revenue integrity efforts for all Medicare Advantage products (inclusive of collaborating with the Employer Group ... of specific functional areas as assigned. Functional areas may include operations , sales, marketing, provider relations, network development, utilization… more
- Centene Corporation (Tampa, FL)
- …+ Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product + Understand and apply all policies and ... procedures pertaining to: + Disclosures and provisions of the Advantage Medicare product + Enrollment and disenrollment + Develop a presence in the local… more
- Point32Health (Canton, MA)
- …a team environment. + Strong understanding of the managed care industry, preferably Medicare Advantage plans. + Experience in Product Development. + Experience ... in product strategy/bid planning meetings led by Product Strategy team to provide subject matter expertise, as needed, on matters related to product design,… more
- Zelis (TX)
- …and communicating rules, regulations, and procedures pertaining to public and private Medicare / Medicare Advantage payment systems. This position requires an ... Position Overview: The Medicare Regulatory Pricer Analyst will collaborate with the...including but not limited to, published fee schedules and provider files, using in-house or off-the-shelf software (such as… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …benefits, customer service, and third-party coverage Preferred: Prior experience with Medicare Advantage including knowledge of regulations, products, and ... benefits information and proactively resolving COB issues. **Job Title: Medicare Benefits Validation Analyst** **Location: Pearland Administrative Office** **Department:**… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans provide peace of mind to more ... database reporting skills. + Basic knowledge of health care operations or health care delivery systems. ** Provider ...includes: A Great Place to Work: + We will provide the equipment you need for this role, including… more
- Elevance Health (West Des Moines, IA)
- …Iowa, positively impacting the affordability of respective Medicaid and Medicare Advantage health plan products. + Develops new provider networks that ... establish a competitive advantage , optimizing respective provider relationships to most effectively benefit health plan growth priorities. + Aligns contracting… 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' ... the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million...their best possible health and quality of life. **_The Provider Credentialing & Data Records Coordinator position allows you… more
- Molina Healthcare (Southaven, MS)
- …in managed healthcare administration. * Specific experience in provider services, operations , and/or contract negotiations in a Medicare and Medicaid managed ... Quality, Operations , and involve Senior Leadership. * Responsible for Provider Satisfaction survey results. * Develops and deploys strategic network planning… more
- University of Colorado (Aurora, CO)
- **Advanced Practice Provider - Nurse Practitioner or Physician Assistant Virtual Primary Care - Sr. Instructor** **Description** **University of Colorado | CU ... Campus** **School of Medicine | Department of Family Medicine** **Advanced Practice Provider - Nurse Practitioner or Physician Assistant - Virtual Primary Care -… more
- Boehringer Ingelheim (Ridgefield, CT)
- …to the design of and development of a Patient Services strategy to provide the optimal patient & provider experience across reimbursement, HUB services, ... companies' success. We realize that our strength and competitive advantage lie with our people. We support our employees...patient support program services for assigned product (s) to provide the optimal patient & provider experience… more