- Providence (WA)
- **Description** **Quality Program Manager - Medicare Advantage Stars** **The Quality Program Manager - Medicare Advantage Stars is tasked with ... result in improved Star ratings.** **The Stars Quality Program Manager will:** + Develop and implement strategies to improve... will:** + Develop and implement strategies to improve Medicare Advantage Star Ratings, driving clinical quality… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …about shaping the future of insurance products? We are looking for a **Associate Product Manager \- Medicare ** to join our dynamic **SeniorCare** team\. ... in a fast\-evolving industry\. Preferred candidates will have a strong background in Medicare / Medicare Advantage products, Excel, CMS guidelines & market… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …create monthly business review report that displays the key metrics of BCBSMA's Medicare Advantage business + Design and develop metrics, reports, and dashboards ... healthcare? Bring your true colors to blue. The Senior Manager of Medicare Strategy and Business Planning...We're Looking for : + Experience in Government Programs, Medicare Advantage Preferred + Ability to develop… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …key relationships throughout the organization including, but not limited to, Medicare Product , Provider Contracting, Health and Medical Management, Actuarial, ... transform healthcare? Bring your true colors to blue. The Medicare Risk Adjustment Strategy Program Manager will...recommendations We're Looking for : + Excellent knowledge of Medicare Advantage risk adjustment programs and industry… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare Advantage Plan visibility in the community by monitoring multiple ... Advisor Primary Responsibilities: + Educate prospects on CPHL MAP product designed for Full Medicaid and Medicare ...issued by Centers Plans for Healthy Living MAP and Advantage Care Medicare HMO Plan. Enrollment application… more
- Datavant (Lincoln, NE)
- …outcomes, measure product impact, and support value-based client delivery across Medicare Advantage , ACA, and Medicaid programs. The ideal candidate combines ... to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Analytics Products, you will contribute to the strategy and… 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** ... of project communications and work with project sponsors or product owners to resolve issues, address changes and identify...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and… more
- CVS Health (Austin, TX)
- …available for highly motivated individual to lead a core team as a Hybrid Field Sales Medicare Manager . This position will be a part of a specialized team who ... achieve monthly sales goals using our competitive portfolio of Medicare Advantage & DSNP products within the... & DSNP products within the assigned market. The manager will support their team with a proven ability… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …activities to ensure that all Commercial (Pharmacy and Medical benefits) and Medicare Advantage Part D coverage determination requests are processed ... to internal partners including but not limited to Member Service, Medicare Operations, Compliance, Legal, Medical Directors, Sales/Marketing/ Product and external… more
- Deloitte (Tempe, AZ)
- …working knowledge of the individual medical and small group markets + Experience with Medicare products, including Medicare Advantage or Medicare ... including disability, long term care, etc. + Experience with product design and/or product strategy + Experience with reimbursement models - including value… more
- Henry Ford Health System (Troy, MI)
- …processing of provider appeals, for all product lines (HMO, AHL, and Medicare Advantage (MA), Medicaid, and Duals) in accordance with internal HAP policies. ... GENERAL SUMMARY: The Clinical Manager , Provider Appeals supports appeals team members to...including NCQA, Department of Labor (DOL) and Center for Medicare /Medicaid Services (CMS). Maintain formal history of provider appeals… more
- Commonwealth Care Alliance (Boston, MA)
- …**Desired Experience (nice to have):** + Experience working in a health plan, with Medicare Advantage and/or dually eligible population + Experience with a care ... Alli-Care Management **Position Summary:** Commonwealth Care Alliance's (CCA) Clinical Care Manager is a registered nurse or other independently licensed behavioral… more
- MVP Health Care (Tarrytown, NY)
- …Plan (EP), HARP, On-Exchange Qualified Health Plans (QHP), Off-Exchange Plans, and Medicare Advantage plans to individuals at Federally Qualified Health Centers ... innovative thinking and continuous improvement. To achieve this, we're looking for a ** Manager , Healthcare Sales** to join #TeamMVP. This is the opportunity for you… more
- CVS Health (Austin, TX)
- …team, including team training, shift management, etc. + Knowledge of Medicare Advantage , chronic condition assessments, or risk adjustment documentation ... day. We are seeking a proactive and highly organized Manager of Production Management to join the Signify Health...compliance, credentialing, and regional deployment plans + Coordinate with product management and IT teams on system enhancements or… more
- Mount Sinai Health System (New York, NY)
- …implementation and contract compliance related to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves ... 400+ employees with clinical, contracting, finance, IT, analytics, operations, and product development expertise. MSHP is a fast growing business unit within… more
- Martin's Point Health Care (Portland, ME)
- …and support to the company, including responsibility for the actuarial support of Medicare product bids, US Family Health Plan (USFHP) rate negotiations with ... a matrix management environment. Job Description Key Outcomes: + Support the annual Medicare Advantage and Prescription Drug (MA/PD) bid development by working… more
- Centene Corporation (Austin, TX)
- …Opportunity**_** **_The ideal candidate will have:_** + **_Deep knowledge of the Medicare Advantage program, with hands-on experience in Dual Eligible Special ... Needs Plans (D-SNPs) (compliance, product , or operations)._** + **_Research skills to track and...Duals and SMAC regulatory filings. + Manages Duals (and Medicare with D-DSNP specific or separate) compliance reporting responsibilities… more
- Elevance Health (Norfolk, VA)
- …trends throughout Virginia, positively impacting the affordability of respective Medicaid and Medicare Advantage health plan products. + Develops new provider ... is a proud member of the Elevance Health family of companies offering Medicare plans, Medicaid, individual and family plans, and group insurance plans in Colorado,… more
- Sedgwick (Meridian, ID)
- …of experts to both learn from and to share your insights. + Take advantage of a variety of professional development opportunities that help you perform your best ... Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier;...of adjusters, clerical staff and provides feedback to hiring manager .\ + Provides limited assistance/support to team lead with… more
- WTW (Fort Lee, NJ)
- …a leading direct-to-consumer insurance services business, specializing in the distribution of Medicare Advantage , Medicare Supplement and Life & Supplemental ... and diverse group of practitioners who collaboratively support all our product categories and cross-functional stakeholders in the finance, marketing, sales,… more
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