- CareOregon (Portland, OR)
- …related to primary care medical home improvement and practice transformation or to the Medicare Advantage performance measures such as Stars, CAHPS, HCC ... Job Title Innovation Specialist - Primary Care/ Medicare Exemption Status Exempt Department Technical Assistance Manager Title Network Innovation Supervisor Direct… more
- Tufts Medicine (Burlington, MA)
- …efficient operation of Medicare Accountable Care Organizations (ACOs) and Medicare Advantage Plans, including performance improvement, clinical ... the Medicare Shared Savings Program (MSSP) and Medicare Advantage programs, plays a crucial role...This position requires a blend of strategic planning, clinical performance improvement skills, a deep understanding of Medicare… more
- HCA Healthcare (Nashville, TN)
- …(CMMI) projects; Accountable Care Organizations (ACO); Advanced Alternative Payment Models; Medicare Advantage including HEDIS performance ; commercial pay ... Children's Health Insurance Program Reauthorization Act (MACRA)/Quality Payment Program (QPP), Medicare Advantage , CMMI projects, ACOs, commercial payor VBC… 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
- 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
- CVS Health (St. Louis Park, MN)
- …Manager who has Medicare market specific P&L accountability for Individual Medicare Advantage products, supporting sales and customer experience agendas in ... member engagement, compliance, and revenue integrity efforts for all Medicare Advantage products. The Market GM will...performance and achievement of the budget of the Medicare plans within the Market. + Collaboration and coordination… more
- Independent Health (Buffalo, NY)
- …of Medicare Advantage and Part D operations and requirements. + Provide support in Medicare product filings, QA, and other requests as identified. ... ability to design and develop adult learning programs OR Medicare Advantage or Part D experience required....and product team and other departments as required/requested. + Provide training and external audience presentations on Medicare… more
- CVS Health (Atlanta, GA)
- …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 (St. Augustine, 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 ... on experience and location. 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
- CVS Health (Salem, OR)
- …a fully remote opportunity to make a meaningful difference in the lives of our Medicare Advantage members. Our CSRs are trusted advocates who provide ... by Workforce Management (WFM). **Key Responsibilities** + Respond to inquiries from Medicare Advantage members via inbound calls, online messages, and written… more
- BroadPath Healthcare Solutions (Honolulu, 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 ... levels are consistently met + Evaluate agent calls and provide coaching with clear performance documentation ....1+ year of recent **healthcare experience** , preferably in Medicare Advantage + Proven ability to coach… more
- BlueCross BlueShield of North Carolina (NC)
- …at least 9 years of relevant actuarial experience. **Bonus Points** + Experience in Medicare Advantage Risk Adjustment highly preferred **What You'll Get** + The ... lead initiatives that directly impact patient outcomes and business performance -whether it's designing innovative insurance products, optimizing pricing strategies,… 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
- Highmark Health (Latham, NY)
- …Medicare services (CMS) laws and regulations, policies and guidelines regarding Medicare Advantage and Medicaid plans; HIPAA privacy and security regulations. ... :** **JOB SUMMARY** This job is the primary liaison between strategically aligned provider groups in the Highmark Network. The incumbent will be responsible for… more
- Molina Healthcare (New York, NY)
- …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
- 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
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …duties and responsibilities as assigned by management Qualifications: + Experience in Medicare Advantage Plan, managed care or healthcare environment at large ... Position Purpose: Configuration and maintenance of provider contracts and benefits Responsibilities: + Configure and...claims related tickets + Train system users + Meet performance goals as established for the position + Perform… more
- BrightSpring Health Services (Louisville, KY)
- …Overview The Chief Operations Officer (COO) is a pivotal member of the Signature Advantage Medicare Advantage (MA) health plan's Executive Leadership team. ... and efficiency. + Deep understanding of all operational aspects of the Medicare Advantage Special Needs Plan including enrollment, claims administration, … more
- ChenMed (Decatur, GA)
- …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