- 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
- UCLA Health (Los Angeles, CA)
- Description As an important member of our Medicare Advantage leadership team, you will provide tactical execution and leadership for our Member and ... Provider Contact Center. Your passion for excellence will help...be responsible for supporting the day-to-day management of the Medicare Advantage department. You will: * Coordinate… 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
- MVP Health Care (Schenectady, NY)
- …implement process improvements. + Knowledge of CMS marketing and sales guidelines for Medicare Advantage plans. + Proficiency in Microsoft Office Suite (Outlook, ... our customers in every interaction **Your key responsibilities:** + Supervise, mentor, and provide ongoing training to a team of Medicare Sales Representatives.… more
- Humana (Columbus, OH)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... in hematology and oncology + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other Medical… more
- Humana (Palm Harbor, 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
- BroadPath Healthcare Solutions (Honolulu, HI)
- …+ Provide operational performance management of a team of Medicare Advantage member acquisition agents + Carry out seasonal full-cycle recruiting ... licensing, product training, on-the-job training, and job placement opportunities in the Medicare Advantage sector. This leader will own the site-level P&L,… more
- CVS Health (Chicago, IL)
- …record of business impact + 5+ years' experience working and understanding Medicare Advantage / Health Insurance concepts including Risk Adjustment and population ... adjustment databases from multiple data sources including CMS, providers and vendor performance . The Senior Manager, Informatics ( Medicare ) will also collaborate… more
- Intermountain Health (Murray, UT)
- …the strategic direction of marketing and communications campaigns for Select Health's Medicare Advantage (MA) and Medicaid lines of business. This position ... of MA and Medicaid products across multiple states. The Medicare and Medicaid Marketing Director reports to a Market... (AP4P) Plan. This plan enables Intermountain Health to provide leaders with an additional performance compensation… more
- AmeriHealth Caritas (Raleigh, NC)
- …of hands-on experience working with Medicaid provider contracts; additional expertise in Medicare Advantage and Exchange plans is highly desirable. + 8 to 10 ... with broader enterprise initiatives. + Lead the design and execution of provider performance improvement plans using data insights, utilization patterns, claims… more
- Elevance Health (AZ)
- …throughout the market, positively impacting the affordability of respective Medicaid and Medicare Advantage health plan products. + Aligns contracting decisions ... of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide...include, but are not limited to: + Develops new provider networks that establish a competitive advantage ,… more
- Molina Healthcare (Antioch, CA)
- …member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, ... Website, etc.). * Medicare subject matter expertise * Trains other Provider Relations Representatives as appropriate. * Role requires 60%+ same-day or overnight… more
- VNS Health (Manhattan, NY)
- …including ICD 10 CM or current coding system and medical record systems for Medicare Advantage Risk Adjustment required + 2 years of experience in coding ... looking for a motivated and dynamic Risk and Quality Provider Educator to travel to provider practice...their quality of life and avoid complications. You'll review performance metrics and patient charts, identifying opportunities to support… more
- Elevance Health (Columbus, GA)
- …for ** Provider Success** is responsible for consulting with providers (Commercial, Medicare Advantage and Medicaid Lines of Business) to assess and deploy ... and participate in culture activities. + Data analytics and ongoing tracking of key performance metrics for each assigned provider + Documentation of all action… more
- Martin's Point Health Care (Portland, ME)
- …+ Knowledge of benefit coverage and servicing members, providers, and the DoD, CMS/ Medicare Advantage , and ME state insurance coverage. + Knowledge of managed ... to Work" since 2015. Position Summary The Senior Director, Claims & Provider Reimbursement, is responsible for oversight of health plan claims administration. The… more
- Elevance Health (Waukesha, WI)
- …trends across all lines of business. + Develops provider networks that provide a competitive advantage . + Aligns contracting strategy with medical management ... provider partnership experience. + Value-Based contracting expertise and performance management experience. + Proven experience developing relationships both… more
- Elevance Health (Columbus, OH)
- …relationships with care providers participating in value-based payment programs for Medicare Advantage , Medicaid (including FIDE), and Commercial lines of ... + Analyze financial performance quality metrics and report the impact on provider performance . + Conduct discussions with employer groups and health system… more
- Molina Healthcare (Milwaukee, WI)
- …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
- Molina Healthcare (Hattiesburg, MS)
- …member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, ... Provider Services. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of… more
- ChenMed (Columbus, OH)
- …and mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to ... be America's leading primary care provider , transforming care of the neediest population. Our mission...goals, and when leading their care teams towards their performance goals. We are an outcomes-focused, value-based organization and… more