- Humana Inc (Boston, MA)
- …a part of our caring community and help us put health first The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an integral part of the Pricer ... Business and System Support team responsible for administering complex Medicare provider reimbursement methodologies. The business needs of the team continue to… more
- Hispanic Alliance for Career Enhancement (Washington, DC)
- …Congress and other key stakeholders in Washington. A strong knowledge of the Medicare Advantage program and Medicare payment systems required with the ability ... Preferred Experience Experience working on one or more of the following Medicare Advantage policy areas: Stars program, Quality Bonus Payments, Medicare … more
- CVS Health Corporation (VT)
- …ways every day.Aetna is recruiting for an AVP, General Manager who has Medicare market specific P&L accountability for the IVL/DSNP products in their market, ... of medical costs management, compliance, and revenue integrity efforts for all Medicare Advantage products (inclusive of collaborating with the Employer Group team… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …is fully remote with the ocassional time onsite as needed. The Sr. Medicare Coverage Analyst (MCA) is responsible for reviewing clinical research protocols, Informed ... which should be billed to the study sponsor. The Medicare Coverage Analyst determines whether proposed clinical research studies...are a Qualifying Clinical Trial as defined by the Medicare Clinical Trial Policy (NCD 310.1) and designates medical… more
- Oklahoma Complete Health (New York, NY)
- Medicare Sales Representative - Bilingual Chinese page is loaded## Medicare Sales Representative - Bilingual Chineselocations: Long Island City - 25-01 Jackson ... access to health insurance, by providing education and assistance to Medicare individuals. Distribute health education materials and arrange for health screenings.… more
- CVS Health Corporation (Hartford, CT)
- …anywhere in the US.\*\* **Responsibilities of this Medical Director role are related to Medicare Appeals:** \* Direct daily work on part C appeals (both provider and ... and Utilization Management Strategy support \* Collaborative work with Medicare Quality and Compliance on an ongoing basis \*...an ongoing basis \* Develop subject matter expertise on Medicare policy for the enterprise \* Provide ongoing education… more
- Humana Inc (Washington, DC)
- A leading health insurance company in Washington is seeking a Sr. Medicare Provider Hospital Reimbursement Analyst to support complex Medicare reimbursement ... with various internal teams, analyzing regulations, and maintaining expertise in Medicare payment systems. Ideal candidates will have experience with reimbursement… more
- Humana Inc (Salt Lake City, UT)
- A leading healthcare company is seeking an experienced Medical Director to review Medicare drug appeals and collaborate with clinical teams. The ideal candidate will ... or DO degree and 5+ years of clinical experience, preferably with Medicare populations. The role includes conducting appeals reviews, engaging in team… more
- Humana Inc (Indianapolis, IN)
- …insurance company is seeking a Medical Director to oversee the review of Medicare drug appeals. The role requires broad clinical expertise and collaboration with ... other healthcare professionals to ensure compliance with Medicare policies. Candidates must possess an MD or DO degree and at least 5 years of clinical patient care… more
- Humana Inc (Phoenix, AZ)
- A leading healthcare provider is seeking a Medical Director to oversee Medicare drug appeals and collaborate with clinical teams to enhance patient care. The ... Responsibilities include conducting complex reviews and ensuring compliance with Medicare rules. Candidates should demonstrate excellent communication and analytical… more
- Econometrica, Inc. (Bethesda, MD)
- …Bethesda, MD. This role requires at least 7 years of experience in Medicare policy development, including drafting and assessing updates. The Analyst will support ... the Centers for Medicare and Medicaid Services (CMS) by analyzing policy changes and mentoring junior staff. This full-time position offers comprehensive training,… more
- Humana Inc (Baton Rouge, LA)
- …healthcare services provider is seeking a Medical Director to oversee Medicare -related clinical operations. The ideal candidate will ensure compliance with national ... and extensive clinical experience. This role offers a competitive salary and the chance to make a significant impact within the Medicare population. #J-18808-Ljbffr more
- CVS Health Corporation (Hartford, CT)
- A major health solutions company is seeking a Medical Director to oversee Medicare Appeals, providing support and education to nursing staff. The ideal candidate ... benefits. Responsibilities include managing appeals processes and collaboration with Medicare Quality and Compliance, ensuring effective operational strategies are… more
- Humana Inc (Atlanta, GA)
- A leading healthcare company in Atlanta seeks a Medical Director to oversee Medicare drug appeals and collaborate with clinicians. The role involves a comprehensive ... understanding of Medicare policies and requires an MD or DO degree with extensive clinical experience. Responsibilities include analyzing drug coverage appeals,… more
- Humana Inc (Springfield, IL)
- …healthcare provider in Springfield, Illinois, seeks a Medical Director to oversee Medicare drug appeals and collaborate with clinical teams to ensure optimal ... minimum of five years of clinical patient care experience, ideally with Medicare populations. This role includes responsibilities such as participating in audits and… more
- Humana Inc (Tallahassee, FL)
- …organization in Florida is seeking a Medical Director to oversee home health and Medicare services. The ideal candidate will have an MD or DO degree, ongoing board ... determinations according to CMS guidelines, conducting case reviews for the Medicare population, and ensuring compliance with regulatory standards. This role is… more
- Humana Inc (Oklahoma City, OK)
- …health insurance company is looking for a Medical Director to oversee Medicare drug appeals and ensure members receive optimal care. Responsibilities include ... collaboration with clinical teams and compliance with Medicare rules and policies. Candidates should possess an MD or DO degree, with at least 5 years of clinical… more
- Humana Inc (Sacramento, CA)
- …is seeking a Medical Director to oversee clinical decision-making and operationalize Medicare and Medicare Advantage requirements. Ideal candidates will possess ... an MD or DO degree, extensive clinical experience, and a commitment to team collaboration. This role involves reviewing medical records, interacting with providers, and ensuring compliance with clinical guidelines. Competitive compensation and benefits are… more
- Oklahoma Complete Health (New York, NY)
- A health insurance provider in New York is seeking a Medicare Sales Representative to enhance market penetration for Medicare products. This role involves ... community outreach, sales presentations, and assisting clients with enrollment processes. Ideal candidates will have a high school diploma, at least one year of sales experience, and be bilingual in Spanish. Competitive salary and benefits package offered,… more
- Humana Inc (Boston, MA)
- A health services company is seeking a Senior Manager, Medicare Sales to lead a team of Medicare Sales Field Agents. This position requires strong leadership, ... the ability to work in the Raleigh Durham, NC area, and a passion for enhancing customer service. Successful candidates will have experience in sales leadership and the insurance industry, and will be responsible for mentoring their team while meeting… more
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