- UCLA Health (Los Angeles, CA)
- …You 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 ... of 5 years' experience with CMS processes in a Medicare or Managed Care environment required * Project... Medicare or Managed Care environment required * Project Management Professional certification is a plus * Experience… more
- UCLA Health (Los Angeles, CA)
- Description A member of the Medicare Advantage Operations leadership team, the Medicare Advantage Enrollment Supervisor is responsible for leading ... include but are not limited to: * Overseeing all aspects of the Medicare Membership Enrollment, Reconciliation, and benefits coordination operations * Represent… more
- R1 RCM (Jenkintown, PA)
- …will be responsible for leveraging your experience and expertise in complex Medicare Advantage payor methodology, payment screenings and experience maneuvering ... will be primarily responsible for researching underpayments as they relate to Medicare Advantage payor population and researching processing issues, examining… more
- CVS Health (Hartford, CT)
- …team, the Manager of Business Consultation is responsible for optimizing Medicare Advantage member journey through process improvement, engagement campaigns, ... Medicare is dedicated to achieving best-in-class quality and value to Medicare Advantage beneficiaries. Optimizing business performance and Star Ratings is a… 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 ... across all lines of business including Commercial fully-insured, self-insured, and Medicare Advantage products. The position will regularly interface with… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. Manages a ... corporate leadership. + 3 years' experience working with healthcare products/programs, preferably Medicare Advantage or government programs. + Proven ability to… more
- reveleer (CA)
- …Collaborate with senior leadership to define and execute the technology operations strategy, including resource planning and technical project management, ... Senior Director, Engineering Operations Location: Glendale, CA or Remote Reveleer is...high-performing team of Integration Engineers, Data Analysts, and Technical Project Managers. Foster a collaborative and innovative culture that… more
- The Cigna Group (Westerville, OH)
- This role is responsible for supporting Cigna Medicare Advantage risk adjustment prospective programs, solutions, and performance in aligned operational region ... Provider Performance Enablement teams, Provider Education, and the Risk Adjustment Operations teams. The Prospective Program Solutions & Performance Advisor works… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …with Marketing, Market Research, Sales, Operations , and Compliance + Oversee Medicare Market project management resources and ensure management of all ... bid process, Blue-to-Blue conversion (age-in) initiatives. Product portfolio includes: Direct Pay Medicare ( Medicare Advantage Prescription Drug Plan, … more
- Medical Mutual of Ohio (Brooklyn, OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. **Responsibilities** ... offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans… more
- Humana (Columbus, OH)
- …and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and/or Medicaid requirements, and will ... **Preferred Qualifications:** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
- CVS Health (Trenton, NJ)
- …Generation Platform Program for the Medicare organization, including products for Medicare Advantage (MA), Medicare Advantage withPrescription Drug ... the team to deliver purpose built configuration for the Medicare Enrollment Operations Team on the NextGeneration...SRs and actively participates as a member of each project team supporting an application orset of applications.* Independently… more
- CareOregon (Portland, OR)
- …execution, and management of the risk adjustment data analytics programs for the Medicare Advantage and Medicaid programs. Assists Director in developing a ... and CMS model + Understanding of the CDPS + Rx model + Understanding of Medicare Advantage and OHP risk adjustment regulations and requirements + Knowledge of… more
- CVS Health (Sacramento, CA)
- …Claim Operations . They will assist the Chief Network Officer and the Medicare Advantage General Manager, in supporting the development and execution of ... capitation processes for market expansion, including the development of market level Medicare Advantage product and network strategies, and management process to… more
- Nucleusteq (AZ)
- …warehouse structures as well as owning data inflows and outflows that support the Medicare Advantage Risk Adjustment teams and efforts. * Design & Development, ... applications consistent with the established specifications and business requirements for the Medicare Advantage Risk Adjustment teams to deliver business value;… 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' ... offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans… more
- HCA Healthcare (Brentwood, TN)
- …projects; Accountable Care Organizations (ACO); Advanced Alternative Payment Models (AAPM); Medicare Advantage ; and commercial payer value programs. This ... projects; Accountable Care Organizations (ACO); Advanced Alternative Payment Models; Medicare Advantage ; commercial pay for performance programs, Meaningful… 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. The Clinical ... offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans… 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 ... position works collaboratively with internal teams including Value Based Operations , Navigation Team, Contract Nurses, Medical Economics, Enterprise Analytics,… more
- American Institutes for Research (MA)
- …new business with CMS, AHRQ, or other HHS agencies. + Extensive knowledge of Medicare payment policy, Medicare Advantage , and/or Medicaid. + Knowledge of ... agencies, including but not limited to the Centers for Medicare and Medicaid Services (CMS). Candidates hired for the...legal compliance to its full integration in our strategy, operations , and work environment. At AIR, we define diversity… more