- Daiichi Sankyo, Inc. (Basking Ridge, NJ)
- …Group's 2025 Vision to become a "Global Pharma Innovator with Competitive Advantage in Oncology," Daiichi Sankyo is primarily focused on providing novel therapies ... SummaryThe Site Contracts and Budgets Management (SCBM) group, in Global Clinical Operations (GCO), develops strategy and provides oversight to all studies in… more
- ProKatchers (Bowling Green, NY)
- …and audit medical charts for compliance with a focus on HEDIS, QARR, Medicare Advantage Star measures and quality improvement activities. This position will ... the annual HEDIS and QARR hybrid medical record review project will be required. This role may also participate...variation from standards of care by audit of core operations , patient care processes and medical record documentation. Designs… more
- 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
- CVS Health (Hartford, CT)
- …team, the Manager of Business Consultation is responsible for optimizing Medicare Advantage member journey through process improvement, engagement campaigns, ... Medicare is dedicated to achieving best-in-class quality and value to Medicare Advantage beneficiaries. Optimizing business performance and Star Ratings is a… more
- LA Care Health Plan (Los Angeles, CA)
- …well as strategic partnerships inclusive of entry onto the Covered CA market. Medicare : Required Medicare Advantage , with experience serving duals ... Product Solutions Manager II ( Medicare ) Job Category: Administrative, HR, Business Professionals Department:...implementation efforts for the product line. Identifies potential risks, project charge, and scope. Recommends in design of appropriate… more
- Universal Health Services (Reno, NV)
- …in 2014. Prominence Health serves members, physicians, and health systems across Medicare , Medicare Advantage , Accountable Care Organizations, and commercial ... across all lines of business including Commercial fully-insured, self-insured, and Medicare Advantage products. The position will regularly interface with… more
- CVS Health (Louisville, KY)
- …and Value Added Benefits.Required Qualifications - At least 5 years of Medicare Advantage product experience - Strong interpersonal and communication skills, ... position, the candidate must have demonstrated experience in Medicaid and Medicare , managing dual materials, including regulatory requirements, and annual filing… 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
- reveleer (CA)
- …Collaborate with senior leadership to define and execute the technology operations strategy, including resource planning and technical project management, ... Senior Director, Engineering Operations Location: Glendale, CA or Remote Reveleer is...high-performing team of Integration Engineers, Data Analysts, and Technical Project Managers. Foster a collaborative and innovative culture that… 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
- Trinity Health (Westerville, OH)
- …(https://www.mcmg.mountcarmelhealth.com/) , a college of nursing (https://www.mccn.edu/) , a Medicare Advantage plan (https://www.medigold.com/) , and extensive ... *2 years of experience in a role which provides operations support * Demonstrated project management skills with the ability to handle multiple projects:… more
- Medical Mutual of Ohio (Brooklyn, 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
- 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
- CVS Health (Trenton, NJ)
- …Generation Platform Program for the Medicare organization, including products for Medicare Advantage (MA), Medicare Advantage withPrescription Drug ... the team to deliver purpose built configuration for the Medicare Enrollment Operations Team on the NextGeneration...SRs and actively participates as a member of each project team supporting an application orset of applications.* Independently… more
- CVS Health (Sacramento, CA)
- …Claim Operations . They will assist the Chief Network Officer and the Medicare Advantage General Manager, in supporting the development and execution of ... capitation processes for market expansion, including the development of market level Medicare Advantage product and network strategies, and management process to… 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
- 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
- HCA Healthcare (Brentwood, TN)
- …projects; Accountable Care Organizations (ACO); Advanced Alternative Payment Models (AAPM); Medicare Advantage ; and commercial payer value programs. This ... projects; Accountable Care Organizations (ACO); Advanced Alternative Payment Models; Medicare Advantage ; commercial pay for performance programs, Meaningful… 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. The Clinical ... offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans… more
