- Merck & Co. (Orlando, FL)
- …Leader, Key Account Manager, Nurse Educator, Field Reimbursement Associate, Medicare Account Executive, and more.Minimum Requirements:Bachelor's degree with at least ... position prior to applying for open positions.If you have been offered a separation benefits package but have not yet reached your separation date and are offered a… more
- South Shore Health (Weymouth, MA)
- …fail to meet criteria and refers these cases to appropriate manager or physician advisor for secondary review. c - Contacts attending physicians daily on cases that ... insurance coverage requirements. Obtains physician written concurrence when necessary; eg, Medicare patients.Informs the patient and/or next of kin when insurance… more
- Marion County (Salem, OR)
- …operational plans to achieve desired outcomes. Serve as a policy advisor to executive leadership to formulate recommendations, policy decisions and strategic ... from participation in the federal health care programs (Medicaid, Medicare and other federally funded programs that provide health... and other federally funded programs that provide health benefits ); AND must not be excluded from participating in… more
- Atrium Health (Charlotte, NC)
- …and understanding of severity based DRG systems; All-Patient Refined and Medicare Severity (APR-DRG), Medical Severity Diagnostic Related Group System (MS-DRG) and ... Hierarchical Condition Categories (HCC). Interacts with the physician advisor , attending physicians, and/or other designated members of the healthcare team when… more
- The Cigna Group (Bloomfield, CT)
- **Legal Compliance Advisor - Medicare Part D/ Rx Service Operations** _Medication Therapy Management (MTM), Formulary, Drug Utilization Review (DUR), Opioid ... Abuse (FWA,) and Clinical Decision Making_ **Role Summary** The Medicare Part D Legal Compliance Advisor is...secure. That's why you'll enjoy a comprehensive range of benefits , with a focus on supporting your whole health.… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Medicare MAP Advisor 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #266 Monday, April 1, 2024 Centers Plan for Healthy Living's goal is to create the ... they need for healthy living. JOB SUMMARY : The Medicare MAP Advisor - Will promote and sale...for educating and enrolling potential beneficiaries by explaining program benefits in a manner that is compliant with Center… more
- Centers Plan for Healthy Living (Bronx, NY)
- …guidance and plans they need for healthy living. JOB SUMMARY : The Licensed Benefits Advisor - Medicare Sales, maintains relationships, services our existing ... Licensed Benefits Advisor (Field Based) Bronx, NY,...in a manner that is compliant with Center for Medicare and Medicaid Services (CMS) and company policies and… more
- BlueCross BlueShield of North Carolina (NC)
- **Job Description** This Consulting Actuary with a Medicare Part D focus on the Medicare Pricing team, will provide pricing, forecasting, and strategic support ... for all Blue Cross NC Medicare products with a particular emphasis on ...Part D topics + Manage relationship with external Pharmacy Benefits Manager as primary point of contact + Experience… more
- WTW (Houston, TX)
- …Together, we unlock potential. Learn more at wtwco.com . **Job Description** As a Benefit Advisor , you will have the rewarding opportunity to speak with ... We design and deliver solutions that manage risk, optimize benefits , cultivate talent, and expand the power of capital...exam in order to be eligible to enter the Benefit Advisor Training program. + After passing… more
- CareFirst (Baltimore, MD)
- …(strategy, design, execution, and optimization) for products and plans in the Medicare , Medicaid, and Federal Employee Health Benefits categories. Leads the ... and membership in line with growth objectives, in the Medicare Advantage Bid process annually, the cost and utilization...Bid process annually, the cost and utilization of all benefits to make adjustments annually, impact of marketing, sales,… more
- Molina Healthcare (Sacramento, CA)
- …is an Equal Opportunity Employer (EOE) M/F/D/V. Key Words: community health advisor , enrollment, Medicaid, Medicare , Medi-Cal, family advocate, health educator, ... liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter and public health, health coach, aide, community lead, community advocate, nonprofit, non-profit, social worker, case worker, housing counselor, human service worker,… more
- CVS Health (Austin, TX)
- …strategy and roadmap to create a clinical operations plan. The Clinical Operations Advisor works with the Benefit Relationship Manager and client to facilitate ... care more personal, convenient and affordable. Position Summary The Clinical Operations Advisor is a client facing role that collaborates with Health Plan Clinical… more
- CVS Health (Irving, TX)
- …The Advisor , Member Copay Billing is a member of the Pharmacy Benefit Management (PBM) Finance Operations Department. The Advisor will play a critical ... for Medicare Part D members utilizing the Medicare Prescription Payment Program (M3P). The Advisor ...offers a full range of medical, dental, and vision benefits . Eligible employees may enroll in the Company's 401(k)… more
- LA Care Health Plan (Los Angeles, CA)
- Compliance Advisor III Job Category: Administrative, HR, Business Professionals Department: Compliance Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... the safety net required to achieve that purpose. Job Summary The Compliance Advisor III ensures that the Plan's processes and operations are compliant with all… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Medical Mutual' s ... and its affiliates on both tactical and strategic levels. The Insights & Analytics Advisor II possesses the technical skills and abilities to help establish the team… more
- Humana (Columbus, OH)
- …our caring community and help us put health first** The Strategy Advancement Advisor plays a crucial leadership role that provides data-driven strategic guidance to ... consistent and best-in-class Provider Engagement function. The Strategy Advancement Advisor enhances operational stability and effectiveness for market-based processes… more
- WelbeHealth (Los Angeles, CA)
- …better quality and compassion in a value-based model. The Senior Care Advisor helps assess PACE eligibility by fostering relationships with prospective participants, ... their caregivers. A trusted telephonic resource, the Senior Care Advisor helps guide seniors who may qualify for the...of prospective participants, educating them about PACE services and benefits to expand our mission to help more seniors… more
- AdventHealth (Altamonte Springs, FL)
- **All the benefits and perks you need for you and your family:** . Benefits from Day One . Paid Days Off from Day One . Debt-free Education* (Certifications and ... **FT** **Shift** : **Days** **The role you'll contribute:** The Onsite Physician Advisor provides primary support for Care Management (CM) and Clinical Documentation… more
- Dignity Health (Gilbert, AZ)
- …Twitter (https://twitter.com/ChandlerRegiona) . **Responsibilities** **Job Summary:** The Physician Advisor plays a critical role in promoting evidence-based ... of claims denials. + Provide compliance element for Centers for Medicare and Medicaid Services (CMS)Conditions of Participation (COP) by performing secondary… more
- Conviva (Hialeah, FL)
- …our caring community and help us put health first** The Patient Service Advisor is an embedded growth and retention associate responsible for executing initiatives ... and providing a personalized care journey. The Patient Service Advisor plays a key role in ensuring success of...the health system and educating them about available resources, benefits , and events. + Conduct 30/60/90 day follow up… more
