- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Care Manger is responsible for facilitating care for members and ... health care disparities, social determinants of health, and any barriers to care . The Clinical Care Manger will engage members in appropriate plans of … more
- UCLA Health (Los Angeles, CA)
- …the integration and publishing of current and legacy sources of Medicare Advantage , managed care , clinical , revenue cycle, and other health system ... with a strong sense of urgency * Extensive healthcare industry knowledge, including Medicare Advantage , professional billing, and data analysis * Ability to… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …from cross functional business leaders to improve the financial performance of BCBSLA's Medicare Advantage (MA) Line of Business (LOB).This is a collaborative, ... and support the SVP, COO of Government Business, and work closely with the Medicare Advantage Finance, Actuarial - both internal and external, Health Care… more
- UCLA Health (Los Angeles, CA)
- …with clinical and non- clinical personnel * Knowledge of the Medicare Advantage STARS program and NCQA technical specifications * In-depth understanding ... at UCLA Health. As a key leader within our Medicare Advantage team, you will develop and...We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of… more
- UCLA Health (Los Angeles, CA)
- …do all this and more at UCLA Health. As an important member of our Medicare Advantage leadership team, you will provide tactical execution and leadership for our ... be responsible for supporting the day-to-day management of the Medicare Advantage department. You will: * Coordinate...We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As a key member of our Medicare Advantage Operations team, you will partner with business and technical teams as well ... experience * Minimum of 5 years' experience in a Medicare or Managed Care environment managing enrollment,...We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of… more
- UCLA Health (Los Angeles, CA)
- …level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll provide direct management to a team of UM ... coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and...managerial experience required * Four or more years of clinical experience providing direct patient care *… more
- UCLA Health (Los Angeles, CA)
- …do all this and more at UCLA Health. As an important member of our Medicare Advantage Operations team, you will be instrumental in maintaining and running ... more years of experience with CMS processes in a Medicare or managed care environment * Must...in the development of breakthrough medical research and outstanding clinical professionals. If you're looking to experience greater challenge… more
- The Cigna Group (Birmingham, AL)
- …group contracting and negotiations** + **Experience with Healthcare - Commercial and Medicare Advantage ** + Experience in developing and managing key provider ... and quality. + Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost… more
- The Cigna Group (Baltimore, MD)
- Leads the development of customer onboarding and marketing plans for the Medicare Advantage customer journey. Communication plans will be multi-modal to include ... communications. The key responsibilities of this role include: + Development of Medicare Advantage customer communication strategy that accounts for customer… more
- Health First (Rockledge, FL)
- …or health plan compliance program operations specializing in Medicare Advantage *Licensure: *None *Certification: * Advanced health care compliance / ... or business field. *Work Experience: * Five years of health plans Medicare Advantage & Individual & Family plans, regulatory or compliance experience.… more
- Healthfirst (New York, NY)
- …membership growth agent responsible for identifying, educating, and enrolling prospective Medicare Advantage (MA) beneficiaries in the appropriate MA plan ... The Medicare Outside Sales Representative is a top performing...Delivery Services Engagement (DSE) team that works with in-network clinical providers to promote Healthfirst and ensure visibility, ultimately… more
- Somatus (Mclean, VA)
- …processing, customer service, enrollment etc. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven track record of ... Overview The Director, Medicare Risk Adjustment (MRA) will lead the execution...the organization's Risk Adjustment Programs to optimize the programs' clinical benefit, financial accuracy and ensure program compliance with… more
- The Cigna Group (Miramar, FL)
- …Components** All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: + ... experience with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage required + Ability and track record of thinking… more
- Universal Health Services (Reno, NV)
- …Health serves members, physicians, and health systems across Medicare , Medicare Advantage , Accountable Care Organizations, and commercial payer ... a comprehensive Care Management and Transitions of Care Program. The Clinical Manager is responsible...exceeds regulatory and accreditation requirements for the Centers for Medicare and Medicaid Services (CMS), state Medicaid offices (as… more
- Martin's Point Health Care (Portland, ME)
- …requirements for member and provider care and service, including CMS/ Medicare Advantage , NCQA. + Demonstrated analytical knowledge and ability to assess ... Join Martin's Point Health Care - an innovative, not-for-profit health care...plans. Martin's Point also administers two health plans: Generations Advantage ( Medicare Advantage plans available… more
- Highmark Health (Pittsburgh, PA)
- …processing arrangements including Federal Employee Program (FEP) and Medicare Advantage . **ESSENTIAL RESPONSIBILITIES** + Coordinates the clinical care ... team of talented Case Managers aims to individualize health care to meet each patient's specific needs with a...lieu of a degree. + 3 years in a clinical nursing role + Current PA RN license +… more
- InnovaCare (San Juan, PR)
- …provider of healthcare management in North America. Through two it's main ways, Medicare Advantage and the provider network, we are committed to healthcare, ... complete the required annual trainings, may not perform his/her clinical duties and care management functions until...that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare … more
- VIP Care (Milton, FL)
- …hospital portal access, state licenses, and professional memberships + Ensure compliance with Medicare Advantage Plans, HIPAA, and labor laws and is responsible ... + Communicate with providers to ensure patient quality of care + Assists with scheduling, administrative, and clinical... care + Assists with scheduling, administrative, and clinical duties for providers (mid-levels and physicians) + Lead… more
- VIP Care (Estero, FL)
- …referral requests, patient records, and medication management + Ensures compliance with Medicare Advantage Plans, HIPAA, labor laws and is responsible for ... value of providing 5-star service that always puts patient care and outcomes first. You'll be part of a...them healthy. THE OPPORTUNITY VIPcare is searching for a Clinical Office Manager (CMA, RMA, MA) to provide preventative… more