- Optum (New York, NY)
- …care setting and working with medically complex patients Working knowledge of Medicare Advantage Risk plans Understanding of HEDIS measurements and delivering ... and out of the hospital, or those with life-limiting illnesses. The physician will lead the team in high-risk patient care and the transition of care management.… more
- Humana (Albany, NY)
- …Humana's Marketing organization is seeking a Product Marketing Lead who is experienced with Medicare Advantage . As the Lead , Medicare Advantage , ... Medicare Advantage ?... Lead the development of go-to-market strategies for Medicare Advantage products, including positioning, messaging, and campaign… more
- Molina Healthcare (Buffalo, NY)
- **Job Summary** The Lead Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Reporting team. Designs and develops reporting ... related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare /MMP * Develops custom health plan reports related to...like Python and R programming would be an added advantage . * Familiarity with Microsoft Azure, AWS or Hadoop.… more
- Humana (Albany, NY)
- …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
- Humana (Albany, NY)
- …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicaid, and Medicare Advantage requirements and will ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
- Humana (Albany, NY)
- …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicare Advantage , and Medicaid requirements and will ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …the guidance and plans they need for healthy living. Outreach and Retention Associate (ORA)- Medicare Advantage CPHL is a Medicare Advantage Prescription ... calls to all prospect leads generated via marketing or lead purchase mediums + Assign prospective appointments to Licensed...products *Licensed Agents Only. + Educate potential members about Medicare Advantage / Special Needs Plans and the… more
- Humana (Albany, NY)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
- University of Rochester (Brighton, NY)
- …Monetary Penalties, and + Medicare and Medicaid billing regulations (including CMS, Medicare Advantage and New York State Medicaid). + Manage disputes, risks ... and Compliance on relevant reimbursement and billing issues and requirements (including CMS, Medicare Advantage , and New York State Medicaid). Stays abreast of … more
- Humana (Albany, NY)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... case reviews of requests received by members of the Medicare population and reports to the Lead ...the Medicare population and reports to the Lead Medical Director.** **Other duties:** + Identify medical management… more
- Humana (Albany, NY)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... case reviews of requests received by members of the Medicare population and reports to the Lead ...the Medicare population and reports to the Lead Medical Director. **Other duties:** + Identify medical management… more
- Molina Healthcare (Syracuse, NY)
- …and oversight of processes that track, evaluate, and submit encounter deletions for Medicare Advantage , ACA, and Medicaid lines of business. This role has ... to identify potential risks to the organization and to lead the needed changes within the encounters process to...Director level role or above. + Extensive understanding of Medicare Advantage , ACA and Medicaid risk adjustment… more
- Humana (Albany, NY)
- …CenterWell and Conviva, delivers care to approximately 300,000 patients from many different Medicare Advantage health plans, and is the largest provider of ... team to develop strategies that support continued growth + Lead the clinical team to partner closely with the...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Molina Healthcare (NY)
- …analytical Reporting modules related to Quality/HEDIS for Medicaid, Marketplace and Medicare /MMP. + Analysis and reporting related to Managed care data like ... for business data issues as assigned by the team lead . + Analyze data sets and trends for anomalies,...like Python and R programming would be an added advantage . + Familiarity with Microsoft Azure, AWS or Hadoop.… more
- Highmark Health (Albany, NY)
- …gain share and risk share models and will be implemented for the Organization's Medicare Advantage , Medicaid, ACA, and commercial populations with the goal of ... for the Organization's value-based reimbursement programs and continuous improvement models. Lead or support key strategic initiatives across Enterprise and Markets… more
- Medtronic (New York, NY)
- …position supports engagement with commercial payers, managed care organizations, and Medicare Advantage plans. Additionally, this role requires experience and ... helping champion healthcare access and equity for all. You'll lead with purpose, breaking down barriers to innovation in...us as we champion healthcare access, drive equity, and lead the evolution of market access in a complex,… more
- New York State Civil Service (NY)
- …training and educating DAEU staff on DQI's data systems and analysis tools. Lead the coordinated effort to design and implement professional data analysis for the ... collected in these systems. . Serve as the Project Lead for the DAEU Team in the building and...maintain eligibility for full and unconditional participation in the Medicare and Medicaid programs. Continued employment will depend on… more
- New York State Civil Service (Albany, NY)
- …The Licensed Psychologist position will serve as the Clinical Quality Team Lead for the Bureau Service Allocation, Research, and Review (BSARR), within the ... utilization review team. The BSARR Licensed Psychologist (Clinical Quality Assurance Team Lead ) will report directly to the Bureau Director. This position will… more
- Tarrytown Rehabilitation & Nursing Center (Auburn, NY)
- …applicants) We are seeking an experienced, results-driven professional to lead our facility's admissions, marketing, and community relations initiatives. This ... team members to evaluate potential residents and determine appropriate placement. + Lead tours, coordinate events, and represent the facility in the community. +… more
- Humana (Albany, NY)
- …learning and content delivery-and we're looking for a product manager to lead the development of capabilities that support broker, agent, and partner education. ... role: owning the roadmap for platforms like Agent Marketing Hub (AMH) and Agent Advantage University (AAU), while acting as an embedded expert within agile pods to… more
