- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …we need: As an integral part of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as an individual ... Ensures required CMS Part C organization determination reporting is accurate + Accurately plan and scope projects; keep project leads, senior consultants, and… more
- CVS Health (Irving, TX)
- …work on a variety of document types and across many contracted relationships. The Senior Analyst will also track document status and work with the team to ... for our clients and helping to make pharmaceuticals more accessible. The Senior Analyst works with multiple internal and external stakeholders to generate, red-line,… more
- CVS Health (Hartford, CT)
- …company's overall growth. The business's key product areas include Individual and Group Medicare Advantage Plans, Prescription Drug Plan , Duals, and the ... and affordable. The Vice President, Human Resources is the senior HR thought-partner to the executive leadership team of...thought-partner to the executive leadership team of the Aetna Medicare business, a business that announced a new leader… more
- Elevance Health (Nashville, TN)
- …synergy with growth partners, providers, regulators, legislators, and thought leaders. + Document requirements from Health Plan contracts with states (SMACs) and ... ** Medicare Duals Management Director-Southeast** **Atlanta GA or Nashville...5-year Duals product and growth strategy for the Health Plan and lead coordinating and facilitating enterprise product/process innovation… more
- Intermountain Health (Columbus, OH)
- …the effective management of assigned contractual associations with payers. The Senior Manager is responsible for high-level, strategic accounts that bring ... **_ng remote workers in the following states: CA, HI, IL, PA, RI, WA._** The Senior Manager is the liaison between Intermountain Health and the payer and works to… more
- Humana (Columbus, OH)
- …the Humana Enterprise Architecture principles, standards, policies and methodologies. As a Senior Enterprise Architect, you play a pivotal role in the alignment of ... creation of technology strategies to leverage the IT. Additionally, as a Senior Enterprise Architect, you will provide mentorship and guidance to other enterprise,… more
- BAYADA Home Health Care (Alexandria, VA)
- …with a recruiter to learn more about opportunities in your area.** BAYADA Senior Living offers a comprehensive continuum of care to its clients, including ... traditional home care under the Medicare Part A benefit, as well as outpatient therapy...BAYADA clinicians become a true healthcare partner in the senior living communities. Communities include assisted living, independent living,… more
- The Cigna Group (Nashville, TN)
- …+ Oversees quality improvement activities for the largest, most complex health plan partners' programs. + Document creation/population to Pathfinder for HEDIS ... an MA-focused group that provides direct and matrixed technology support for Cigna's Medicare Advantage and CareAllies business units. Our goal is to simplify how… more
- Elevance Health (Columbus, OH)
- …but not limited to: claim adjudication procedures; insurance law; benefit design; plan document provisions and compliance regulation strongly preferred. + ... **Rating/Claims System Senior Advisor** **Location:** This position will work a...as related to claims processing. + Responsible for monitoring Medicare changes as they relate to claims payment and… more
- EssilorLuxottica (Mason, OH)
- Senior Analyst - Business Data (Reporting Design) Date: Apr 15, 2024 Brand: EyeMed Vision Care Location: Mason, OH, US, 45040 **Requisition ID:** 841486 ... with America's fastest growing vision benefits company. **GENERAL FUNCTION** The Senior Analyst is responsible for implementing, executing and supporting routine and… more
- University of Colorado (Aurora, CO)
- Advanced Practice Provider - Nurse Practitioner or Physician's Assistant Senior Instructor - 30744 Faculty **Description** **University of Colorado | CU Anschutz ... **POSITION RESPONSIBILITIES/DUTIES -** + New tasks appear continuously throughout the day, plan to check in-box continually during clinic hours and over the lunch… more
- CVS Health (Woonsocket, RI)
- …more personal, convenient and affordable. POSITION SUMMARY: The Strategic Procurement Senior Analyst Vendor Management manages Print and Direct Mail projects and ... oversight of, and engagement with; Ariba, Contracts, Third Party Risk, Medicare Compliance, AP, Sourcing, and internal/external Auditors. Lead annual supplier… more
- City of West Sacramento (West Sacramento, CA)
- Senior Recreation Leader SPARK Print (https://www.governmentjobs.com/careers/westsacramento/jobs/newprint/4470745) Apply Senior Recreation Leader SPARK Salary ... The City of West Sacramento is seeking professionals to serve as a Senior Recreation Leaders in the Adaptive Recreation Program, SPARK. This is a part-time… more
- Highmark Health (Harrisburg, PA)
- …inbound phone sales inquiries and make outbound follow-up calls to perspective Highmark Medicare and DSNP members. + Document outcomes accurately in sales ... record of meeting/exceeding individual and business unit targets. + Knowledge of Medicare markets including plan offerings + Sales background **LICENSES AND… more
- University of Michigan (Ann Arbor, MI)
- Data Architect Senior Apply Now **How to Apply** All applicants must submit a cover letter and resume as a single document to be considered for this position. ... genetics, administrative (including claims and assessment files from the Center for Medicare and Medicaid Services (CMS)) and other files that may increase risks… more
- Humana (Columbus, OH)
- …a position on the Security Configuration Management Team at Humana. The Senior Security Configuration Management Engineer ensures that assets connected to our ... mandates and security best practices such as CIS Benchmarks. The Senior Security Configuration Management Engineer work assignments involve moderately complex to… more
- The Cigna Group (Bloomfield, CT)
- Clinical Program Senior Advisor - BCGP / LTC Focused **POSITION SUMMARY** + The Senior Clinical Geriatric Consultant Pharmacist will support quality, safety, and ... for claims adjudication, formulary management and STAR metrics. + Develop, document , and execute intervention plans utilizing the most clinical and economical… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …meetings and on organizational project teams, and frequently interact with senior leaders, and/or functional peer group managers. + Develop business requirements ... + Developing PowerPoint presentations, policy cases and policy summary briefs *This document is not an exhaustive list of all responsibilities, skills, duties,… more
- Healthfirst (New York, NY)
- …with business leaders on implementation of CAP/MAP (Corrective/Management Action Plan (s) to help improve operational efficiency and effectiveness; as well ... appropriate solutions to problems. + Prepare reports to adequately document audit or test results and to support conclusions...least two or more lines of business such as Medicare NY, Medicaid, Child Health Plus, QHP, EP, HARP.… more
- Conduent (Denver, CO)
- …including but not limited to reports for agencies such as the Centers for Medicare and Medicaid Services (CMS) + Develop and maintain data models and schemas to ... federal reporting requirements into existing systems and processes. + Document technical specifications, data mappings, and reporting processes. Qualifications: +… more