- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. What We Need The Medicare Advantage Network Performance Manager, as a member of a ... and coding, and product management and marketing. To accomplish this work, the Medicare Advantage Network Performance Manager will work closely with… more
- CareOregon (Portland, OR)
- …This position is responsible for managing actuarial analysis related to Medicaid and Medicare Advantage lines of business with a focus on supporting strategic ... Medicaid capitation rates, overseeing the actuarial components of the Medicare Advantage bid pricing, and analyzing historical...plans and goals for actuarial analysis of the financial performance of Medicaid and Medicare lines of… more
- BlueCross BlueShield of North Carolina (NC)
- …of go-to-market strategies. + Develop and maintain actuarial models to support the Medicare Advantage Part D bid process + Provide proactive and strategic ... thought leadership relating but not limited to pharmacy network , formulary, and Medicare Part D topics...such as competitive health benefits, bonus plans based on performance , 401(k) with employer match, paid time off (plus… more
- Universal Health Services (Reno, NV)
- …in 2014. Prominence Health serves members, physicians, and health systems across Medicare , Medicare Advantage , Accountable Care Organizations, and commercial ... Learn more at: https://prominence-health.com/ Job Summary: The Supervisor of Medicare Enrollment is responsible for supervising the day-to-day operations of… 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...the Delivery Services Engagement (DSE) team that works with in- network clinical providers to promote Healthfirst and ensure visibility,… 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...and partner requirements. + Drives industry best practices and performance results focusing on driving key KPI's (# visits,… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …in supporting the contracting regions with quality, utilization, and cost analysis. **Provider Network Performance Analyst I** + Gathers and maintains data from ... contracting initiatives. + Performs other duties as assigned. **Provider Network Performance Analyst II** + Conducts quality...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and… more
- Zelis (St. Petersburg, FL)
- …distinctive chance to craft top-tier recruitment strategies aligned with our expanding Medicare Advantage Network . Key Responsibilities + Identify, recruit, ... driven by a passion for achieving results in this performance -oriented role. Their primary responsibility involves securing signed contracts...strong network relations + Manage PPO and Medicare Advantage recruitment efforts and network… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. Manages ... offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans… more
- CVS Health (Indianapolis, IN)
- …and parameters, or accuracy of provider contract or demographic information. Network Performance /Oversight . Recruits' providers as needed to ensure ... In-depth knowledge of managed care business, regulatory /legal requirements. . Medicare Advantage knowledge and experience Education Bachelor's degree… more
- St. Luke's University Health Network (Easton, PA)
- …on a broad range of human resource issues; including employee relations, performance management and ensuring consistency on goal setting, pay positioning and ... performance differentiation and distribution. + Facilitates employee relations activities...supporting the organization's culture, in order to maximize competitive advantage and the talents of the workforce. + Develops… more
- Corus Health (Albuquerque, NM)
- …care preferred. + Required payer experience - worked with a Medicaid, Commercial or Medicare Advantage payer network . + Demonstrated ability in program ... continued success in beautiful Albuquerque, New Mexico. Ensemble is a Clinically Integrated Network of post-acute and senior care providers. Its purpose is to bring… more
- CVS Health (Sacramento, CA)
- …Payment team, Capitation Analytics team, and Claim Operations. They will assist the Chief Network Officer and the Medicare Advantage General Manager, in ... capitation processes for market expansion, including the development of market level Medicare Advantage product and network strategies, and management… more
- The Cigna Group (Charlotte, NC)
- …Components** All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: + ... STARS, HEDIS, Risk Adjustment and medical expense reduction, preferably specific to Medicare Advantage + **Leadership:** 3+ years management experience required… more
- InnovaCare (San Juan, PR)
- …the leading provider of healthcare management in North America. Through two it's main ways, Medicare Advantage and the provider network , we are committed to ... to serves as primary liaison between enrolled beneficiaries, provider network and MMM & MSO, for the purposes of...that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare … more
- InnovaCare (Ponce, PR)
- …the leading provider of healthcare management in North America. Through two it's main ways, Medicare Advantage and the provider network , we are committed to ... a conglomerate of companies that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare y Mucho Mas (MMM),… more
- InnovaCare (Guaynabo, PR)
- …the leading provider of healthcare management in North America. Through two it's main ways, Medicare Advantage and the provider network , we are committed to ... a conglomerate of companies that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare y Mucho Mas (MMM),… more
- InnovaCare (San Juan, PR)
- …the leading provider of healthcare management in North America. Through two it's main ways, Medicare Advantage and the provider network , we are committed to ... a conglomerate of companies that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare y Mucho Mas (MMM),… more
- Cleveland Clinic (Cleveland, OH)
- …quality, cost, and utilization data preferred. + Knowledge of ACO, Medicaid, and Medicare Advantage quality measures, NCQA and HEDIS standards, and Medicare ... \#LI-WG1 #LI-REMOTE Keywords: Value Based Care, Value Based Contracts, Value Based Performance , Value Based Program, Medicaid, Medicare , Population Health Pay… more
- InnovaCare (Guayama, PR)
- …the leading provider of healthcare management in North America. Through two it's main ways, Medicare Advantage and the provider network , we are committed to ... a conglomerate of companies that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare y Mucho Mas (MMM),… more