- Highmark Health (Buffalo, NY)
- …are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with ... STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the needs… more
- CVS Health (Blue Bell, PA)
- …in this role will serve as the subject matter expert for Aetna's Medicare Advantage Special Needs Plans (SNP) business. Includes Dual Eligible, HIDE/FIDE ... Chronic plans. The SNP population presents a huge growth opportunity for Medicare Advantage plans, and Aetna is aggressively expanding into this market. This… more
- CNO Financial Group (Chicago, IL)
- …skills and location. This position is bonus eligible.** The Account Representative - Medicare Advantage is responsible for working with all internal and external ... team members ( Medicare Advantage and other insurance carriers) in contributing to building strong relationships while ensuring implementations and communications… more
- Humana (Concord, NH)
- **Become a part of our caring community and help us put health first** Individual Medicare Advantage (iMA) Rapid Solutions owns the MA Pricing Model (web app ... annual pricing of Humana's largest segment of business, individual plan Medicare Advantage . The team consists of actuaries and business technology professionals… more
- BlueCross BlueShield of North Carolina (NC)
- …The Episodic Care Manager is responsible for performing clinical reviews to assess, facilitate, and coordinate the delivery of health care services for members based ... on medical necessity and contractual benefits. Effectively coordinate with providers, members, and internal staff to support the delivery of high quality and cost-effective care across the health care system. **What You'll Do** Clinical Evaluation and Review +… 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. This position ... of Medical Mutual's Medicare Compliance Program, which supports both Medicare Advantage and Medicare Supplement products. Reporting directly to the Chief… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare Advantage Plan visibility in the community by monitoring multiple ... equipment issued by Centers Plans for Healthy Living MAP and Advantage Care Medicare HMO Plan. Enrollment application process + Ensures prospective members are… more
- CVS Health (Downers Grove, IL)
- …with internal senior level corporate compliance and business teams that operate Medicare Advantage in a highly complex regulatory environment and highly ... and teamwork **Required Qualifications:** + 7+ years' experience in Medicare or Medicare Advantage government healthcare program compliance or regulatory… more
- Humana (Miami Lakes, FL)
- …Based Role:** + **Deliver** : Build trust and educate individuals on Humana's Medicare Advantage plans and additional offerings like Life, Dental, Vision, and ... Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help… more
- UCLA Health (Los Angeles, CA)
- …Senior Product Manager to lead the design, development, and implementation of our Medicare Advantage products. In this role, you'll partner with the Director ... and compliance throughout the member lifecycle. Key Responsibilities: + Lead end-to-end Medicare Advantage product development. + Support and help manage the… more
- Humana (Columbus, OH)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand ... and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in a medical… more
- Humana (Helena, MT)
- …and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will ... Qualifications** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid products, or other Medical management organizations,… more
- BrightSpring Health Services (Bowling Green, KY)
- …of Business Abilis Health Plan, an affiliate of BrightSpring Health Services, is a Medicare Advantage Plan covering all the benefits of Original Medicare ... Abilis Health Plan Overview * Abilis Health Plan was formerly Signature Advantage * We are seeking a Sales Account Representative/Executive for our Abilis Health… more
- CVS Health (Concord, NH)
- …of medical costs management, compliance, and revenue integrity efforts for all Medicare Advantage products (inclusive of collaborating with the Employer Group ... every day. Aetna is recruiting for an AVP, General Manager who has Medicare market specific P&L accountability for the IVL/DSNP products in their market, supporting… more
- Erickson Living (Tinton Falls, NJ)
- …benefits. + Be knowledgeable of all applicable CMS regulations and guidelines of specific Medicare Advantage Plans. + Create sales events intended to allow new ... Village by Erickson Senior Living We are hiring a Medicare Sales Agent, also known as our Health Insurance...and their families on matters pertaining to the Erickson Advantage Health Plan and insurance matters in general. Erickson… more
- Commonwealth Care Alliance (Boston, MA)
- …ensuring accurate, compliant, and timely reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director of ... Experience (nice to have):** + Prior experience working with MassHealth and Medicare Advantage reimbursement rules is strongly preferred. **Required Knowledge,… more
- Robert Half Office Team (Kansas City, MO)
- …turn into a contract to hire opportunity. 100% Onsite. Responsibilities: + Sell Medicare Advantage plans, Medicare Supplement plans, and related products ... Description We are looking for a dedicated Licensed Medicare Specialist to join an insurance company in Kansas City, Missouri. This is a long-term contract position… more
- Intermountain Health (Murray, UT)
- …needed to develop a strong performing product. **Preferred Qualifications** + Knowledge of Medicare Advantage products, which could come from work experience in ... Partner leads the development and management of a portfolio of high-impact Medicare products within the government programs division at Select Health, overseeing… more
- Southeast Health (Dothan, AL)
- …Using internal and external computer systems and payer portals, work traditional Medicare and Medicare Advantage /Replacement inventory to full resolution. ... to obtain accurate reimbursement; + Understands the use of and navigation of Medicare 's DDE system and other governmental and commercial payer websites for claim… more
- Centene Corporation (Charleston, WV)
- …role in shaping the annual budget and quarterly financial forecasts across all 32 Medicare Advantage markets. + **Collaborative Team Culture** : Join a group ... ASA designation and are looking to continue growing their actuarial career in ** Medicare financial forecasting, actuarial analyses, and bid support** . **ASA or FSA… more
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