- Centene Corporation (Queens, NY)
- …is critical in managing end-to-end provider engagement, contract modeling, and performance oversight for Medicare Advantage and Dual Eligible Special ... + Oversee Medicare -specific VBP contracts, focusing on implementation, performance management, and education of provider partners regarding CMS-aligned… more
- Providence (WA)
- **Description** **Quality Program Manager - Medicare Advantage Stars** **The Quality Program Manager - Medicare Advantage Stars is tasked with serving as ... Quality Program Manager will:** + Develop and implement strategies to improve Medicare Advantage Star Ratings, driving clinical quality indicators (HEDIS Star… more
- BlueCross BlueShield of North Carolina (NC)
- …of degree, 7+ years of experience in related field **Bonus Points** + Deep Medicare and/or Medicare Advantage regulatory experience + Extensive Medicare ... the business/organization. + In the course of investigation, may be required to provide deposition and/or testimony May also be required to conduct interviews of… more
- UCLA Health (Los Angeles, CA)
- Description As the Business Data Analyst for our Medicare Advantage Risk Adjustment team, you will be responsible for producing accurate and insightful ... reports. + Write clear specifications and design data queries for healthcare performance measures. + Apply technical expertise to gather requirements and translate… more
- Centene Corporation (Providence, RI)
- … performance of Medicare -focused VBP arrangements across New York, including Medicare Advantage and Dual Eligible Special Needs Plans (D-SNPs). This role ... is critical in analyzing provider performance , modeling contract terms, and generating...organization drive population health improvements and financial sustainability through Medicare VBP strategies. + Partner with Contract management and… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …create monthly business review report that displays the key metrics of BCBSMA's Medicare Advantage business + Design and develop metrics, reports, and dashboards ... expense to suggest business improvements and efficiencies + Lead Medicare provider strategy workgroup by working with...We're Looking for : + Experience in Government Programs, Medicare Advantage Preferred + Ability to develop… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …considerations and recommendations We're Looking for : + Excellent knowledge of Medicare Advantage risk adjustment programs and industry trends + Knowledge ... experience. + 6-8 years of relevant experience, preferably in health insurance + Medicare Advantage and Prescription Drug Plan experience a plus #LI-HYBRID… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …+ Solid understanding of Medicare and its related financial models, including Medicare FFS, Medicare Advantage , Medicare Part D, and ... work collaboratively with both technical and non-technical staff including Underwriting, Medicare Product Development, Provider Contracting, Sales, and others… more
- CVS Health (Nashville, TN)
- …will direct key team resources and associated project responsibilities managing Individual Medicare Advantage , Special Needs Plans (SNP) including Medicare ... in new and exciting ways every day. Aetna is recruiting for a VP, Medicare Territory Leader who will have overall accountability for the territory P&L and general… more
- Humana (Olympia, WA)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand ... radiology, and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in… more
- Humana (Palm Bay, FL)
- …Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to ... us put health first** Are you passionate about the Medicare population, looking for an opportunity to work in...applicants selected for leader review may be asked to provide their social security number, if it is not… more
- Kelly Services (Greece, NY)
- …line with established policies and procedures. + Maintaining current knowledge of Medicare Advantage regulations and corporate policies. + Skillfully resolving ... performance guidelines and standards set forth by the Medicare Division and the Centers for Medicare ...individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information… more
- Elevance Health (Woodbridge, NJ)
- …and prospective risk adjustment initiatives, operational effectiveness and efficiencies, provider performance , and population health. **How You Will ... not limited to: + Analyzes and develops SAS and SQL programming to support Medicare Advantage risk adjustment initiatives. + Performs data mining and data-driven… more
- Humana (Frankfort, KY)
- …strategy. Humana's Law Department is seeking a Counsel who will support its Medicare Advantage and Medicaid lines of business by: Providing legal advice ... managed care and value-based contracting on behalf of a health plan or provider /vendor organization + Medicare and/or Medicaid provider contracting… more
- BroadPath Healthcare Solutions (Kapolei, HI)
- …lead a high-performing team of licensed sales agents who help consumers enroll in Medicare Advantage and Prescription Drug Plans. This is your chance to step ... in telesales + 1+ year of recent **healthcare experience** , preferably in Medicare Advantage **Diversity Statement** _At BroadPath, diversity is our strength.… more
- Henry Ford Health System (Troy, MI)
- …and planning and marketing support. Coordinate the development and implementation of Medicare Advantage sales strategies, compliance activities and oversight for ... GENERAL SUMMARY: Responsible for the retention and growth of the Medicare line of business (both Individual and Group) accounting for more than $400 million in… more
- Humana (Tallahassee, FL)
- …productive. Our wholly owned affiliate, CarePlus, operates in 18 Florida counties, offering Medicare Advantage HMO plans that have been awarded 5-Star ratings by ... Vice President. **Key Responsibilities** + Initiate, negotiate, and execute value-based Medicare Advantage contracts and agreements with physicians and other… more
- Elevance Health (Nashville, TN)
- …Tennessee, positively impacting the affordability of respective Medicaid and Medicare Advantage health plan products. + Develops new provider networks that ... of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide...establish a competitive advantage , optimizing respective provider relationships to most effectively benefit health plan growth… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …by management Qualifications: + Minimum of 10 years of healthcare operations or Medicare Advantage experience; strong knowledge of Medicare Advantage ... The Provider Inquiry Manager provides leadership and oversight of...dispute manual, SOP, workflows and policies and procedures + Provide on-going training and coaching to staff + Develop… more
- Molina Healthcare (Los Angeles, CA)
- …member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, ... a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines… more