- Curana Health (West Yarmouth, MA)
- …of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health ... living communities. In this role, you'll serve as a trusted provider for residents by delivering high-quality, person-centered care, building strong relationships… more
- Highmark Health (Buffalo, NY)
- …and provides strategic, hands-on, office based support to PCPs for analysis of performance Medicare STARS, Medicaid HEDIS and risk revenue streams, identifies ... are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with… more
- Banner Health (Phoenix, AZ)
- …outcomes. In this pivotal role, you'll shape strategy, inspire innovation, and elevate performance across Medicare Advantage and quality programs. If you're ... accountable care organization that joins Arizona's largest health care provider , Banner Health, and an extensive network of primary...Improvement. The Senior Director acts as a catalyst and Medicare Advantage Star and Quality subject matter… more
- CVS Health (Concord, NH)
- …of medical costs management, compliance, and revenue integrity efforts for all Medicare Advantage products (inclusive of collaborating with the Employer Group ... the overall financial performance and achievement of the budget of the Medicare plans within the Market. + Direction of senior leaders of specific functional… more
- Humana (Sanford, FL)
- …Based Role:** + **Deliver** : Build trust and educate individuals on Humana's Medicare Advantage plans and additional offerings like Life, Dental, Vision, and ... Humana apart. + **Grow** : Drive self-generated sales, meet performance goals, and expand Humana's presence in the market...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over… more
- Humana (Lincoln, NE)
- …This includes the following key responsibilities: + Develop product strategy for annual Medicare Advantage plan filings + Lead the expansion and support for ... and plans for the Region; drives financial and operational performance ; and coordinates activities of senior managers and their... engagement activities for all lines of business + Medicare Advantage experience + Preferred location is… more
- Humana (Harrisburg, PA)
- …This includes the following key responsibilities: + Develop product strategy for annual Medicare Advantage plan filings + Lead the expansion and support for ... provider engagement activities for all lines of business + Medicare Advantage experience **Additional Information** This position will require approximately… more
- Intermountain Health (Murray, UT)
- …needed to develop a strong performing product. **Preferred Qualifications** + Knowledge of Medicare Advantage products, which could come from work experience in ... for Performance (AP4P) Plan. This plan enables Intermountain Health to provide leaders with an additional performance compensation opportunity. The AP4P… more
- Fallon Health (Worcester, MA)
- …external SLA's. With speed, accuracy, and integrity, ensures that enrollee data for Medicare Advantage , Medicare Supplement, NaviCare, Summit Elder Care, ... improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and… more
- Commonwealth Care Alliance (Boston, MA)
- …HOS) and value-based contract performance metrics + Experience with Medicare Advantage , Medicaid; and dually eligible populations **Desired Experience** + ... Provider Engagement, Network, Clinical and Quality teams to evaluate provider performance , identify opportunities for improvement, and facilitate data-driven… more
- Health Care Service Corporation (Chicago, IL)
- …CMS regulatory requirements, including Medicare Marketing Guidelines + Experience with Medicare products (including Medicare Advantage , Medicare ... and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The … more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Care Quality and Manager (CHQM) * Registered Nurse * Solid knowledge of Medicare Advantage Business Compensation and Benefits: Pay Range: $88,600.00 - ... HEDIS and Stars. Your Responsibilities As part of a Blue Cross provider - performance consultation team, this role * Identifies opportunities for provider … more
- Molina Healthcare (Dallas, TX)
- …member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, ... a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines… more
- ChenMed (Oak Lawn, IL)
- …and mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to ... be America's leading primary care provider , transforming care of the neediest population. Our mission...goals, and when leading their care teams towards their performance goals. We are an outcomes-focused, value-based organization and… more
- Health Care Service Corporation (Richardson, TX)
- …Job Qualifications:** + MBA or MHA. + Health care industry experience. + Medicare Advantage knowledge and expertise. + Commercial, Affordable Care Act knowledge ... Delivery and network and value-based care program evolution, where high value provider partners are targeted for participation. Leader must work collaboratively with… more
- OhioHealth (Columbus, OH)
- …delivery model. This includes the OhioHealth Clinically Integrated Network (CIN) Medicare Advantage and Commercial contracts, OhioHealth Venture Medicare ... Key responsibilities include: * Supporting the team accountability of value-based contract performance in the Medicare , Commercial and Medicaid spaces by… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …working weekends and requires frequent travel to various Centers Plans or Healthy Living Advantage Care Medicare HMO Plan sites located throughout the five (5) ... boroughs. Territory Management + Maintain Centers Plans for Healthy Living Advantage Care Medicare HMO Plan visibility in the community by monitoring multiple… more
- Ventura County (Ventura, CA)
- …expertise in mental health billing, including CPT, ICD-10, and HCPCS coding for Medicare and Medi-Cal. Skilled in the Medi-Cal Provider Manual and TAR ... codes, Health Care Procedure Coding System (HCPCS) codes for payment processing of Medicare and/or Medi-Cal. + Medi-Cal Provider Manual for Billing and Policy… more
- Blue KC (Kansas City, MO)
- …+ 5+ years of provider facing experience + Strong knowledge of Medicare Advantage and Qualified Health Plans (ACA) including Stars and Risk Adjustment ... KC tools and incentive programs focused on improving the quality of care for Medicare Advantage & Qualified Health Plan (ACA) Members. + Establish positive,… more
- Amazon (New York, NY)
- …will responsible primarily for several critical workstreams which include analysis of Medicare Advantage and Accountable Care Organization data, design and ... performance compared to plan expectations. Key job responsibilities -Analysis of Medicare Advantage and Accountable Care Organization data primarily -Medical… more
