- Molina Healthcare (Long Beach, CA)
- …collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and ... of claims and appeals and resolves grievances related to medical quality of care. + Attends or...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- CVS Health (Sacramento, CA)
- …to make health care more personal, convenient and affordable. Position Summary The Director of Client Management - Medicare Product will have the opportunity ... lead our client acquisition and retention strategy for our Medicare specific products. The Director will be...includes performance trends impacting Star ratings Preferred Qualifications + Quality ratings experience with Medicare plans +… more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- CVS Health (New York, NY)
- …for energetic team member to bring discipline and strategic thinking to our Medicare Marketing Efforts. The Lead Director , Medicare Marketing Strategic ... critical role in enabling, optimizing and advancing the Aetna's Medicare Marketing. This role will serve as a key...complex /fast paced environment with senior and executive leader quality and professionalism + Proven ability to lead planning… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Director , Group Medicare Sales and Labor Relations sells health insurance and related ... 300+ contracts) and leads the Labor Relations team. The Director , Group Medicare Sales and Labor Relations...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- Somatus (Mclean, VA)
- Overview The Director , Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation of the organization's Risk Adjustment Programs to ... ensure program compliance with governing bodies' regulations, including the Center for Medicare and Medicaid Services. This role will partner with leadership to… more
- CVS Health (Santa Ana, CA)
- …growing business. CVS Health/Aetna is working to transform the way California Medicare beneficiaries experience health care - improving quality , emphasizing ... Manager to support the growth of our industry leading Medicare business. This is a highly collaborative role in...the United States and will report to the Sales Director for Southern California. This is a career position… more
- CVS Health (Atlanta, GA)
- …care more personal, convenient and affordable. As the Senior Manager, Risk Adjustment ( Medicare ) will be responsible for leading Risk Adjustment for the Georgia & ... the Gulf States Medicare Market. This role will have specific responsibility for...adjustment teams, risk coding improvement activities within the region, medical record collection, provider collaboration and data sharing, general… more
- CVS Health (Jackson, MS)
- …care more personal, convenient and affordable. As the Senior Manager, Risk Adjustment ( Medicare ) will be responsible for leading Risk Adjustment for the Georgia & ... the Gulf States Medicare Market, specifically in Mississippi. This role will have...adjustment teams, risk coding improvement activities within the region, medical record collection, provider collaboration and data sharing, general… more
- The Cigna Group (Bloomfield, CT)
- Pima County based - Medicare Provider Performance Enablement (PPE) Senior Analyst provides broad support to Sr. Supervisor, Sr. Manager, Director , and Other ... interaction with PPE staff as well as other Cigna Medicare departments. Position is exposed to all aspects of...internal departments, including but not limited to Health Services, Medical Economics, Sales and Coding in order to develop… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …your true colors to blue. What we need: As an integral part of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through ... decision making + Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical ...and scope projects; keep project leads, senior consultants, and Director informed of key issues/ risks and meet deadlines… more
- The Cigna Group (Miramar, FL)
- …experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage required + Ability ... & Solutions). Reporting to the Provider Performance Senior Manager/Operations Director /Operations Senior Director (Market President), the Provider Performance… more
- Elevance Health (Columbus, OH)
- … management, medical staffing, seasonality issues, detailed communications with the medical director , and nurse leader. Collaborate with HSO and Carelon on ... **RVP & President Medicare Market (Ohio)** **Location:** This role requires the...SMAC (DSNP) contract requirements for regulatory reporting, encounter reporting, quality audits, HEDIS/EPSDT, state relationships for DSNP, and other… more
- Elevance Health (Morristown, NJ)
- … management, medical staffing, seasonality issues, detailed communications with the medical director , and nurse leader. Collaborate with HSO and Carelon on ... **RVP & President Medicare Market (Northeast Region)** **Location:** This role requires...SMAC (DSNP) contract requirements for regulatory reporting, encounter reporting, quality audits, HEDIS/EPSDT, state relationships for DSNP, and other… more
- CVS Health (Lansing, MI)
- …is working to transform the way Michigan experience health care - improving quality , emphasizing whole-person wellness, and driving down costs. Aetna is hiring a ... Manager to support the growth of our industry leading Medicare business. This is a highly collaborative role that...leads, and overall, in-person sales activity - Local sales director will provide guidance on expectations for field visits… more
- The Cigna Group (Birmingham, AL)
- …maintain Cigna's competitive position. + Creates and manages initiatives that improve total medical cost and quality . + Drives change with external provider ... member of the Provider Contracting Team and reports to the Provider Contracting Director . This role assists in developing the strategic direction and management of… more
- BrightSpring Health Services (Arlington, TX)
- …other specialized care centers nationwide. If your passion is service excellence and top- quality care come join our team and apply today! Responsibilities + Act as ... Achieves productivity goals with regard to calls/claims per hour as determined by the Director and Clinical Hub Manager + Provide clinical support to members of the… more
- BrightSpring Health Services (Arlington, TX)
- …other specialized care centers nationwide. If your passion is service excellence and top- quality care come join our team and apply today! Responsibilities + Acts as ... productivity goals with regard to calls/claims per hour, as determined by the Director and Clinical Hub Manager. + Prioritizes work to meet daily and competing… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify ...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director (Staff Geriatrician or Physician with Ten (10) Years...need it. These efforts are leading to a better quality of life for people with Medicare ,… more