- Prime Therapeutics (Pierre, SD)
- …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
- Centene Corporation (Cheyenne, WY)
- …compliance. + Serve as the primary liaison between Provider Engagement, Internal Medicare Operations /Value Based team, and Shared Services, ensuring alignment ... will have a strong background in project management, data analysis, and healthcare operations (emphasis on claims and configuration), with expertise in Medicare … more
- TEKsystems (Honolulu, HI)
- The Medicare Specialist will oversee claims processing operations , ensuring accuracy, efficiency, and compliance with regulatory requirements. This role requires ... will manage both onshore and offshore vendor relationships and support seamless operations across Medicare , Medicaid, and commercial insurance lines of business.… more
- AmeriHealth Caritas (Baton Rouge, LA)
- …in Business, Government, or health care management; + 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...service functions to drive adherence.; + Partner with Service Operations on Plan performance regarding significant functions related to… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …+ Maintain strong relationships throughout the organization including, but not limited to, Medicare Product, Medicare Operations , Medicare Compliance, ... (PDE), pharmacy performance guarantees, security audits, and other Production Operations duties + Oversee Medicare Part D Claims audits to ensure that all MAPD… more
- CVS Health (Hartford, CT)
- …Key Responsibilities: + Manage and support the core business application used for Group Medicare operations . + Collaborate closely with the Medicare Product ... every day. Position Summary We are seeking a Senior Manager to join our Medicare Product Tech team, supporting the business applications that power our Group … more
- CVS Health (St. Louis Park, MN)
- …development, member education, and other activities as requested by the Director of Medicare Operations and as customer service demands allow. Examples may ... we do it all with heart, each and every day. **Position Summary** As a Medicare Member Advocate supporting the Allina Health | Aetna plan, you will engage with… 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
- USAA (San Antonio, TX)
- …healthcare fraud investigation reviews. + Knowledge of health insurance claims operations , particularly Medicare Supplement claims handling (eg, claims, ... talented **Medical Specialist Principal** to play a crucial role in advising the Medicare Supplement Claims Department on the morbidity and claims risk of health… 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
- Centene Corporation (Dover, DE)
- …Director and Care Coordination Director to manage and optimize LTSS and Medicare -Medicaid Duals program operations , focusing on improving quality metrics and ... initiatives for both the Long-Term Services and Supports (LTSS) and Medicare -Medicaid Duals populations. Additionally, the Medical Director will collaborate with… more
- CVS Health (St. Louis Park, MN)
- …more valuable health insurance solution for Minnesotans. Our Allina Health/Aetna Medicare health plan currently serves approximately 27,000 Medicare ... annual revenue. Aetna is recruiting for an AVP, General Manager who has Medicare market specific P&L accountability for Individual Medicare Advantage products,… more
- Molina Healthcare (Cleveland, OH)
- …benefits, operations , communication, reporting, and data exchange of the Medicare /MMP product in support of strategic and corporate business objectives. Support ... for all Medicare lines of business the annual Medicare ...responsible for the planning, support, and oversight of all operations of the business unit. Sees all annually recurring… more
- Centene Corporation (New York, NY)
- …for our 28 million members. **Position Purpose:** Develops and operationalizes the Medicare portfolio including Medicare Advantage and Prescription Drug Plan ... (PDP), Employer Group and Medicare Supplemental plans. Works closely with actuary, finance national...in two of the following areas: Product Development, Product Operations , Marketing & Sales, Strategic Planning, and/or Network Management.… more
- CVS Health (Atlanta, GA)
- …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
- CareOregon (Portland, OR)
- …home or Medicare + Thorough and applied knowledge of clinic operations and charting systems + Applied knowledge and experience with quality improvement tools ... Job Title Innovation Specialist - Primary Care/ Medicare Exemption Status Exempt Department Technical Assistance Manager Title Network Innovation Supervisor Direct… 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
- Aston Carter (Honolulu, HI)
- Description The Senior Enrollment Manager is responsible for the operations of the companies Enrollment Department which includes enrollment/disenrollment ... of enrollment information and demographic changes (including coordination of benefit, Medicare Secondary Payer and Medicare Late Enrollment Penalty information),… more
- CVS Health (Harrisburg, PA)
- …opportunity available for highly motivated individual to lead a core team as a Field Medicare Manager. The position will be a part of a specialized team who will ... focus on educating existing Medicare members on available plan offerings to help meet...+ Maximize the operational effectiveness of the Field Sales operations (eg. Sales, conversions, quality) by leveraging DTC Field… more
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