- Cambia Health Solutions, Inc (Renton, WA)
- …to drive performance improvements in critical objectives such as population health management, Medicare Stars , and Risk Adjustment.Here are some of the exciting ... our team as a Government Programs Provider Performance Director!Preferred Key Experience : Familiarity with Medicare Advantage and its business modelExperience… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …related to quality metrics and value-based contracts, care gaps, Quality Improvement, Medicare Stars , HEDIS measures and patient medical needs.Ability to develop ... the multi-disciplinary population health team approach by providing knowledge and experience to support performance in our value-based contracts. The Population… more
- CVS Health (Hartford, CT)
- …care more personal, convenient and affordable. Position SummaryAs a member of the Medicare Stars Member Experience team, the Manager of Business ... of actions supporting broad-based, regional and local actions to maximize Medicare member experience and engagement for the enterprise.Aetna Medicare… more
- CVS Health (Richmond, VA)
- …or auditing programs + 1-3 years Medicare managed care experience + Experience with Medicare STARS and Part D Formulary benefits + Knowledge of ... other clinical programs + Communicate to providers, pharmacies, and members on quality, STARs , or FWA indicators for Medicare programs + Provide clinical… more
- CVS Health (Austin, TX)
- …Completion of a PGY1 Managed Care residency + Certified in MTM + Bilingual + Experience with Medicare STARS and Part D formulary benefit Education Registered ... in a recent Medicare Managed Care Clinical Pharmacy Role focused on Stars or HEDIS measures *Clinical Pharmacist Role: + Established clinical experience in… more
- The Cigna Group (Baltimore, MD)
- …the assigned **(Mid-Atlantic (MD, DC & VA) region** as evidenced by physician and member satisfaction, improvements on Stars and NPS score. + Managing our Costs: ... The Provider Performance External Representative is a key member of the market that assists in the...direct provider-facing experience or direct health plan experience with STARS , HEDIS, Risk Adjustment and… more
- LA Care Health Plan (Los Angeles, CA)
- …with experience serving duals population. Direct experience in Medicare and Duals program administration including stars , quality, financial performance ... Product Solutions Manager II ( Medicare ) Job Category: Administrative, HR, Business Professionals Department:...and specific strategic initiatives in support of optimizing the member experience while managing the ongoing evolution… more
- Elevance Health (Richmond, VA)
- Wellpoint, formerly Amerigroup, is a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide ... Cost of Care, trend management, value-based care support for STARS /HEDIS and correct coding initiatives with providers as well...the US. + Minimum of 10 years of clinical experience ; or any combination of education and experience… more
- Elevance Health (Columbus, OH)
- **RVP & President Medicare Market (Ohio)** **Location:** This role requires the leader to be based in Ohio. Relocation assistance may be available. **Summary** ... operational, and regulatory management for both large and complex Medicare Health plans in Ohio. The role aligns strategy...and to grow CSNP, as well as to drive Stars performance. + Oversee and participate in the development… more
- The Cigna Group (Nashville, TN)
- …organization. **Qualification:** + Bachelor's degree strongly preferred + 4+ years relevant experience with managed Medicare and provider engagement + ... You'll Do** The National Value-Based Contracting Account Owner position is an integral member of the National Network team and will be responsible for ensuring… more
- Health First (Rockledge, FL)
- …to accrediting and regulatory agency inquiries and audit requests including CMS, Medicare Stars , NCQA, and any other regulatory requirements. 7. Facilitate ... strategic plans to support population health goals and initiatives to meet member needs across the continuum of care, including Integrated Care Program clinics.… more
- CVS Health (Columbus, OH)
- …and engaging decisionmakers. + Identification of cross-enterprise initiatives necessary to achieve Stars and Member Experience objectives. + Responsibility ... Providing information, expert opinion and thought leadership needed to support the attainment of Stars and Member Experience Objective. + May represent the … more
- CVS Health (New York, NY)
- …to drive the next level of Medicare product and service quality and member experience at a leading national B2C healthcare brand. We're looking for aspiring ... data enthusiasts to drive member engagement and behavior change in Aetna's ...organization. The team is organized by business-aligned verticals - Medicare STARS , Revenue Integrity, Duals COE, Foundational… more
- LA Care Health Plan (Los Angeles, CA)
- …of business. Experience in improving Stars and Quality Measures. Experience in Medicare Advantage, with experience serving duals population. Direct ... operational processes that impact quality scores, enrollment, revenue and member retention. Design appropriate mitigation and contingency plans. Lead... experience in Medicare and Duals program administration including stars ,… more
- Insight Global (Woonsocket, RI)
- …client of ours. They will be part of the Informatics team with Aetna, focusing on Medicare stars applications called stars central. It focuses in on Tableau ... age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected...of SQL Server experience required. * Cloud experience (Azure of GCP) * Health insurance, Medicare… more
- CVS Health (Hartford, CT)
- …#GRS Group Retiree Solutions (GRS) is a core component of the Aetna Medicare Organization. Our vision is to develop an industry-leading group retiree health care ... sponsors and their members. We aspire to provide personalized, member -centric care that treats retirees like human beings during...team. This position is a key driver of additional Medicare Group Retiree growth opportunities as we partner with… more
- Universal Health Services (Reno, NV)
- …+ At least 5 years of health care experience working with value based Medicare Advantage STARS /HEDIS programs. + At least 3 years of health care ... tools that will result in leveraging information to manage member analytics in order to more effectively direct resources...experience working with Medicare and/or Commercial risk… more
- Humana (Indianapolis, IN)
- …programs while interacting with plan members and providers in order to improve member patient experience , to drive population health, and to ensure efficient ... Director/Chief Medical Officer) is dedicated full-time to the Contractor's Indiana Medicare & Medicaid Integrated program, Indiana PathWays for Aging. He/she will… more
- The Cigna Group (Seattle, WA)
- …of services in the assigned **Seattle, WA territory** as evidenced by physician and member satisfaction, improvements on Stars and NPS score. Managing our Costs ... **Role Summary:** The Provider Performance Lead Analyst is a key member of the market that assists in the growth and development of the provider network. The Lead… more
- The Cigna Group (Atlanta, GA)
- …organization (which includes Market Provider Performance, Sales, Clinical Operations, Stars & Risk Adjustment, Finance , Cross-Segment Contracting, Provider ... agreements and financial and/or operational issues with providers. + Leading Stars & Risk Adjustment outcomes through local Provider Performance initiatives.… more
