- Medical Mutual of Ohio (OH)
- …responsible for leading the implementation and day-to-day management of Medical Mutual's Medicare Compliance Program, which supports both Medicare Advantage ... **Responsibilities:** + Manages the implementation and operation of the Medical Mutual Medicare Compliance Program. + Serves as Medical Mutual's Medicare … more
- Humana (Chicago, IL)
- …for licensed, highly motivated and self-driven individuals to join our team. Our Senior Manager , Medicare Sales, motivates and drives a team of Medicare ... and train a team of sales individuals. The Senior Manager , Medicare Sales, must have a solid...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- CVS Health (Concord, NH)
- …in new and exciting ways every day. Aetna is recruiting for an AVP, General Manager who has Medicare market specific P&L accountability for the IVL/DSNP products ... market performance, cost structure and local execution of medical costs management, compliance , and revenue integrity efforts for all Medicare Advantage products… more
- UCLA Health (Los Angeles, CA)
- Description We're seeking a strategic Senior Product Manager to lead the design, development, and implementation of our Medicare Advantage products. In this ... role, you'll partner with the Director of Medicare Product Development and Bids to guide the annual bid process, drive cross-functional initiatives, and ensure… more
- Corewell Health (Grand Rapids, MI)
- Job Summary - Manager Medicare Stars Quality Improvement Manages the Quality and Senior Quality Improvement Specialists and their work. Responsible for the ... and for facilitating change through internal team building. Essential Functions - Manager Medicare Stars Quality Improvement + Supports quality improvement… more
- BlueCross BlueShield of North Carolina (NC)
- **Job Description** The Manager , Medicare Claims, oversees end-to-end claims services for provider segments, meeting business goals. This role sets performance ... gathering, preparation, analysis, and reconciliation of financial data to ensure compliance with accepted accounting principles and standards. + Participate in… more
- Houston Methodist (Katy, TX)
- …Access Services, and Utilization Review as needed to ensure operational billing compliance with government/regulatory agencies and the Medicare and Medicaid ... At Houston Methodist, the Manager Revenue Cycle position is responsible for the...guidance to staff and is responsible for staffing, budget compliance , contributing to staffing decisions such as hiring and… more
- CVS Health (St. Louis Park, MN)
- …it all with heart, each and every day. **Position Summary** As the **Senior Manager of Stars** , you will lead the market-wide strategy, performance improvement, and ... execution of the Medicare Stars quality program...(HEDIS, Clinical Operations, Network, Pharmacy, Product, Member Experience, Data/Analytics, Compliance ) to implement evidence-based interventions. + Partner with external… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …with the guidance and plans they need for healthy living. JOB SUMMARY : The Medicare MAP Advisor- Will promote and sale MAP and Medicare Line of Business, ... performing all required tasks assigned by the Sales Field Manager . Incumbent will be responsible for educating and enrolling...in a manner that is compliant with Center for Medicare and Medicaid Services (CMS) and company policies and… more
- Humana (Tampa, FL)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...Agents, you'll work under the guidance of a Senior Manager and Regional Director who are committed to your… more
- OhioHealth (Columbus, OH)
- …Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position ... will be responsible for ensuring the appropriate governmental ( Medicare and Medicaid) reimbursement is received for OhioHealth. * This position is primarily… more
- Fallon Health (Springfield, MA)
- …in our service area, and who have MassHealth Standard, and may have Medicare . It combines MassHealth (Medicaid) and Medicare benefits, including prescription ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief summary of purpose:**… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... LinkedIn. **Brief summary of purpose:** Under the direction of the Manager 's, the Eligibility and Revenue Operations Representative supports Fallon Health's mission,… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan has an exciting opportunity for a Supervisor, Medicare Sales Support position located in the Medicare & SNP Sales department. This is a full ... and in office 2 days per week. The Supervisor, Medicare Sales Support staff will manage daily supervision and...and achieve improvements within the department. + Attend all compliance /leadership training as required. + Assist team in increasing… more
- Corewell Health (Grand Rapids, MI)
- …of the member appeal and fair hearing review processes for all non- Medicare products to thoroughly investigate appeal requests, leveraging critical thinking skills, ... systems, and collaboration to resolve issues whenever possible. Ensure compliance with all mandated, legislative, regulatory and accreditation requirements. Assist… more
- Elevance Health (Tampa, FL)
- **Medical Director- Florida Medicare Plans** Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... Tampa locations.** The **Medical Director** will support the following Florida Medicare plans: Simply Healthcare Plans, Healthsun Plans, Freedom Health, and Optimum… more
- Hartford HealthCare (Farmington, CT)
- …guidelines, keeps abreast of all regulations and standards to ensure compliance with governmental/regulatory agencies or third-party payers, responsible for Epic ... in the process of interviewing applicants and provides feedback to hiring manager . Assists in the onboarding and training of new AR Collections Specialists.**… more
- CenterWell (Santa Fe, NM)
- …to obtain details necessary for prioritization (eg member experience improvements, compliance impacts, client goals, etc.) + Create project intake and prioritization ... of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Point32Health (Canton, MA)
- …who we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Senior Manager , Compliance Program will manage the day-to-day operations of ... and direct administration of activities, projects, and personnel necessary to ensure compliance with Medicare , Commercial and Medicaid laws and regulations and… more
- Atlantic Health System (Morristown, NJ)
- The Compliance and Privacy Manager oversees, in pertinent part, the following compliance risk areas: (i) general compliance and compliance program ... privacy, information governance, and data risk classification; (iv) accountable care organization compliance ; (v) Medicare C & D/ Medicare Advantage … more