- ICF (Reston, VA)
- …ensure alignment and adherence. + Identify and recommend opportunities for process improvement, system integration, and innovative uses of CMS data. + Work ... solutions, and translate ideas into actionable strategies and deliverables. + Familiarity with CMS programs such as Medicare , Medicaid, or Marketplace. + Strong… more
- Centene Corporation (Queens, NY)
- …Oversee Medicare -specific VBP contracts, focusing on implementation, performance management , and education of provider partners regarding CMS -aligned models, ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- The Cigna Group (Bloomfield, CT)
- …position will provide external actuarial analytics support within the regulated Medicare market and Pharmacy Benefit Manager (PBM) Healthplan space. This actuarial ... to provide a designated full time support to Express-Script's external client's Medicare Part D business. This role will matrix with internal leadership within… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …by explaining program benefits in a manner that is compliant with Center for Medicare and Medicaid Services ( CMS ) and company policies and regulations. The ... + AHIP certified + Computer/technology literacy + Compliant with CMS and CPHL policies. + Follow CPHL, CMS...CPHL sites located throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare … more
- CVS Health (Boston, MA)
- …candidate will have deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management , and pricing strategies. This role requires a strong ... Experience, preferably in the Healthcare Industry. + 5+ years of experience in Medicare Advantage actuarial pricing, bid development, and CMS Part C/D… more
- Molina Healthcare (Albany, NY)
- …** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & ... issues, steer partners toward durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements.… more
- Wider Circle (Newark, NJ)
- …dynamic boutique insurance agency that's transforming the way people navigate their Medicare benefits! At Ask Claire, we are passionate about empowering underserved ... in people's lives while growing your career in a thriving, impactful organization. Medicare Sales Representative At Ask Claire, a subsidiary of Wider Circle, we… more
- Prime Therapeutics (Oklahoma City, OK)
- …our passion and drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs - Remote, Pennsylvania **Job Description** Manages the ... coordination of benefits in the pharmacy program with Medicare Part D plans. Provides the technical and leadership...that have impacts on members, providers, Part D plans, CMS , and the company. Requires a working knowledge of… more
- Centene Corporation (Providence, RI)
- …the organization drive population health improvements and financial sustainability through Medicare VBP strategies. + Partner with Contract management and ... improvement or innovation in VBP strategies. + Assist in building and refining Medicare contract models, incorporating CMS and NYSDOH guidelines related to risk… more
- Wider Circle (Los Angeles, CA)
- …Scope of Appointment, the presentation of the product, sales conversion and relationship management of a Medicare beneficiary * Daily tasks include completing a ... a fast-growing boutique insurance agency focused on helping people understand their Medicare Benefits. We work with underserved populations to help them navigate … more
- Providence (WA)
- …clinical quality (Stars HEDIS) measures, CAHPS, HOS + Deep understanding of the Medicare Advantage Stars program, CMS Star Rating Technical Notes, HPMS memos, ... **Description** **Quality Program Manager - Medicare Advantage Stars** **The Quality Program Manager -...Expert (SME) who is experienced at using Stars data, CMS Star Rating Technical Notes and HPMS memos to… more
- BlueCross BlueShield of North Carolina (NC)
- …practices with complex coding patterns and reports relevant data to the Centers for Medicare and Medicaid Services ( CMS ). **What You'll Do** + Analyzes necessary ... coding and reports relevant data to the Centers for Medicare and Medicaid Services ( CMS ). + Uses...Documentation, Medical Insurance Coding, Medical Record Analysis, Medical Records Management , Medicare , Medicare Plans, Payment… more
- Molina Healthcare (San Antonio, TX)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the ... to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight, monitoring and… more
- OhioHealth (Columbus, OH)
- …or Finance. + Hospital and/or healthcare industry experience. + Understanding of the CMS prospective payment system and State of Ohio regulations. + Minimum ... **We are more than a health system . We are a belief system .**...This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities.… more
- Commonwealth Care Alliance (Boston, MA)
- …option based on financial ability and forecasting for small to large Operations Management + Collaborate system and data configuration into CES (Claims Editing ... Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr....standard coding logic and policies (ie . Center for Medicare & Medicaid Services ( CMS ) & MA… more
- Molina Healthcare (Tacoma, WA)
- … Medicare . * Serves as Molina Medicare 's liaison to federal ( CMS ) regulatory and plan management staff. * Responsible for regulatory filings related ... areas for Molina Medicare . Serves as Molina Medicare 's liaison to federal regulatory and plan management... Medicare 's liaison to federal regulatory and plan management staff. The Director is responsible for regulatory filings… more
- AmeriHealth Caritas (Southfield, MI)
- …psychosocial needs. This role ensures that care is delivered by Centers for Medicare & Medicaid Services ( CMS ), state, and organizational guidelines, within the ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Humana (Olympia, WA)
- …radiology, and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in ... a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with national guidelines… more
- The Cigna Group (Bloomfield, CT)
- …matter expert (SME) on Medicare Prescription Drug Coverage, Express Scripts Medicare Programs and Products and CMS Regulations. This client-facing position ... team. The leadership and strategic direction you'll provide will better educate our Medicare clients on the products we offer and give their members' access to… more
- Fallon Health (Springfield, MA)
- …for enrollments. + Must keep up to date all records related to leads in CRM system , Account Management Grid and any other report requested by your manager. + ... area, and who have MassHealth Standard, and may have Medicare . It combines MassHealth (Medicaid) and Medicare ...completed applications in a timely manner as required by CMS . **4.Tracking & Reporting** + Documents all sales activities… more