- Prime Therapeutics (Oklahoma City, OK)
- …Works to ensure established rules, policies, and procedures are implemented so that Medicare Part D operations are successful, efficient, auditable and in ... Level + 5+ years + 5+ years + Required + Yes + Yes + Details + Medicare + Operations Must be eligible to work in the United States without the need for work visa… more
- CVS Health (Boston, MA)
- …team focused on enhancing pricing accuracy, optimizing bid strategies, and supporting Medicare operations through advanced analytics and actuarial insights. Key ... We are seeking a strategic and technically proficient leader to oversee Medicare data science initiatives supporting actuarial analytics and pricing. The ideal… more
- AmeriHealth Caritas (Southfield, MI)
- …more about us at www.amerihealthcaritas.com. **Role Overview:;** Reporting to the Supervisor of Medicare LTSS Operations , the Medicare LTSS Care Coordinator ... needs. This role ensures that care is delivered by Centers for Medicare & Medicaid Services (CMS), state, and organizational guidelines, within the scope… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …development, operations , financing and revenue generating programs + Knowledge of Medicare Part D program, operations and industry trends + Proven ability ... transform healthcare? Bring your true colors to blue. The Medicare Risk Adjustment Strategy Program Manager will report to...Program Manager will report to the Senior Director of Medicare Risk Adjustment and Analytics. This role will manage… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to internal partners including but not limited to Member Service, Medicare Operations , Compliance, Legal, Medical Directors, Sales/Marketing/Product and external ... to help us transform healthcare? Bring your true colors to blue. The Pharmacy Operations Clinical Pharmacist Manager manages and directs clinical staff in the day to… more
- AmeriHealth Caritas (Baton Rouge, LA)
- …or health care management; **Skills & Abilities** + In-depth understanding of Medicaid/ Medicare operations and benefit administration + Proven experience in ... Ops and Admin is responsible for leading the Plan Operations for the LA Medicaid plans. This role will...preferred; + 5 or more years operational experience in Medicaid/ Medicare + 10 or more years progressive responsibility in… more
- Molina Healthcare (St. Petersburg, FL)
- …Sales, Enrollment, UM, Case Management, Claims, and other departments within Molina Medicare and Medicaid regarding A&G operations and dependencies. * ... Summary** Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and… more
- Henry Ford Health System (Troy, MI)
- …and propose business requirements; serve as operational business unit SME for the Medicare sales Operations and Retention team; attend daily stand-up meetings, ... Responsible for assisting with all Salesforce initiatives for the Medicare Advantage line of business from the scoping phase through mapping and overall execution;… more
- CAI (Erie, PA)
- …be responsible for ensuring a welcoming and efficient environment at the Medicare Center, assisting customers, and supporting daily operations . **Job ... be responsible for ensuring a welcoming and efficient environment at the Medicare Center, assisting customers, and supporting daily operations . **What You'll… more
- UCLA Health (Los Angeles, CA)
- Description The Business Data Analyst plays a key role within the Medicare Advantage Operations team, acting as a liaison between business units, IT teams, and ... system requirements, analyzing and interpreting data to support cross-functional operations , and driving system enhancements to improve efficiency and compliance.… 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 requirements ... 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
- UCLA Health (Los Angeles, CA)
- …do all this and more at UCLA Health. As a key member of our Medicare Advantage Operations team, you will develop detailed requirements specifications to meet our ... update training documentation + Generate ad hoc reports to support the operations team Salary Range: $76,200 - $158,800/annually Qualifications We're seeking a… more
- Drips (IL)
- …provider experience + Familiarity with CMS quality programs, member engagement, or Medicaid/ Medicare operations About Drips Drips is a fast-growing, tech-enabled ... managed service transforming how health plans engage their members at scale. As the pioneer of Conversational AI-as-a-Service, Drips helps healthcare organizations connect with hard-to-reach members to drive measurable outcomes across the member journey-… more
- TEKsystems (Chesapeake, VA)
- Medicare Patient Account Specialist You'll enjoy Full Time Day Shift Hours - Monday-Friday 8:00am-4:30pm for 2-4 weeks of training (after training can establish ... the area A day in the role . Submit Medicare / Medicare Advantage plan claims both electronic and...our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions.… more
- CVS Health (Nashville, TN)
- …in new and exciting ways every day. Aetna is recruiting for a VP, Medicare Territory Leader who will have overall accountability for the territory P&L and general ... management responsibilities for the Medicare business in the Southeast territory which includes the...Aetna's position in the market. + Knowledge of Aetna's operations and marketing processes and strategies. + Ability to… more
- Commonwealth Care Alliance (Boston, MA)
- …This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for ... as necessary on all new and revised coding logic, related Medicare /Medicaid policies for review/approval through the Payment Integrity governance process.… more
- Centene Corporation (Houston, TX)
- …to competitive benefits including a fresh perspective on workplace flexibility. ** Medicare Field based sales position for Houston, TX** **Position Purpose:** Provide ... access to health insurance, by providing education and assistance to Medicare individuals. Distribute health education materials and arrange for health screenings.… more
- CNO Financial Group (Carmel, IN)
- …and location. This position is bonus eligible.** The Account Representative - Medicare Advantage Account Representatives is responsible for working with internal and ... external team members in managing our Medicare Advantage carrier relationships and distribution of their products. Contributes to building strong relationships while… more
- Elevance Health (Louisville, KY)
- ** Medicare Risk Adjustment Advanced Analytics Consultant** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per week,** ... unless an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics Consultant** is responsible for employing advanced… more
- SUNY Upstate Medical University (Syracuse, NY)
- …Nurse (RN), or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) across seven Primary Care clinics. This role ... The RN/CNS will report to the UUMAS Director of Quality and Practice Operations and collaborate closely with Primary Care clinic Medical Directors and Nurse… more