- Commonwealth Care Alliance (Boston, MA)
- …HOS) and value-based contract performance metrics + Experience with Medicare Advantage , Medicaid; and dually eligible populations **Desired Experience** + ... Provider Engagement, Network, Clinical and Quality teams to evaluate provider performance , identify opportunities for improvement, and facilitate data-driven… more
- USAA (Plano, TX)
- … brokered products including Final Expense, Universal Life Insurance, Medicare Advantage & Prescription Drug Plans. Coordinates training/onboarding/development ... What you'll do: Leads and develops a team of professional licensed advisors to provide best in class Health, Life, or Retirement advice and solutions to members to… more
- Caris Life Sciences (Irving, TX)
- …Billing to support a seamless patient and provider experience. + Provide regular reporting and analysis of eligibility performance , including KPIs, denial ... cross-functional initiatives and manage timelines, resources, and deliverables. + Experience with Medicare Advantage plans and familiarity with Xifin is a plus.… more
- Commonwealth Care Alliance (Boston, MA)
- …**Desired Experience (nice to have):** + Experience working in a health plan, with Medicare Advantage and/or dually eligible population + Experience with a care ... oversight, routine and post discharge assessments, providing health education, and provider collaboration. Consults, as needed, with other participants of the… more
- Commonwealth Care Alliance (Boston, MA)
- …- Healthcare non-profit, consulting and/or startup experience is a plus - Medicare Advantage and/or Managed Medicaid strategy, operations, and policy experience ... base compensation, you may qualify for a bonus tied to company and individual performance . We are highly invested in every employee's total well-being and offer a… more
- Mom's Meals (Ankeny, IA)
- …and compliant billing, following specific regulations of multi-state Medicaid and MCO's, Medicare Advantage , and Older Americans Act programs + Responsible ... data to identify and resolve billing discrepancies + Demonstrate successful performance through accuracy, timeliness, and customer satisfaction metrics + Utilize… more
- Health Care Service Corporation (Chicago, IL)
- … + Knowledge of Medicare Advantage provider networks, Medicare Advantage key performance indicators, trends, and financial acumen + Knowledge ... the team to support divisional short and long-term initiatives related to Medicare provider network strategy and leverage analytics to drive provider network… more
- Highmark Health (Pittsburgh, PA)
- …and provides strategic, hands-on, office based support to PCPs for analysis of performance Medicare STARS, Medicaid HEDIS and risk revenue streams, identifies ... are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with… 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
- 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
- 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 ... Humana apart. + **Grow** : Drive self-generated sales, meet performance goals, and expand Humana's presence in the market...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over… more
- CVS Health (Hartford, CT)
- …investments. **Business Performance & Communications** + Align KPIs across Medicare ; provide early-warning signals and recommend corrective actions. + Lead ... progressive Healthcare experience, including strategy/finance/actuarial with demonstrated focus on Medicare Advantage + Executive-ready communication skills; able… more
- Humana (Louisville, KY)
- …Financial or actuarial background + Medicare Risk Adjustment Experience + Medicare Advantage or Healthcare Industry Experience + Experience building Power BI ... decisions on day-to-day operations, strategic planning and specific business performance issues. The Financial Analytics Professional work assignments are varied… more
- Elevance Health (Costa Mesa, CA)
- …regulations. The position also provides formulary strategy support across Elevance Health's Medicare Advantage Prescription Drug (MAPD) business. **How you will ... ** Medicare Formulary Strategy Manager** **Hybrid 1:** This role...product offering. **Group Retiree Solutions (GRS) Clinical Support** + Provide formulary strategy and clinical support for GRS programs.… more
- Commonwealth Care Alliance (Boston, MA)
- …(must have): * Strong working knowledge of MassHealth ACO/MCO requirements and CMS ( Medicare Advantage ) regulations. * Expertise in 42 CFR Part 422, MassHealth ... and federal healthcare regulations, particularly MassHealth (Massachusetts Medicaid) and CMS Medicare requirements. This role is housed within the Claims Operations… 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
- Sharp HealthCare (San Diego, CA)
- …commercial and Medicare business (HMO, PPO, HAS, POS, Medicare Advantage ) to stay up-to-date on their provider activities, programs, and initiatives for ... and corrective action plans, as needed.Develops and implements action plans for provider performance improvement based on annual timely access provider… more
- Highmark Health (Charleston, WV)
- …Medicare services (CMS) laws and regulations, policies and guidelines regarding Medicare Advantage and Medicaid plans; HIPAA privacy and security regulations. ... well as enforcement of company policies and procedures while increasing provider efficiencies, performance , and maximizing quality (STAR/HEDIS). Responsible for… more
- Lumeris (NH)
- …management + Demonstrated subject matter expertise in any of the following areas: Medicare advantage , Medicare Shared Savings Program (MSSP), managed care ... its people and empowers you to make an impact. **Position:** Provider Engagement Specialist **Position Summary:** Responsible for improving Accountable Care Team… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Care Quality and Manager (CHQM) * Registered Nurse * Solid knowledge of Medicare Advantage Business Compensation and Benefits: Pay Range: $88,600.00 - ... HEDIS and Stars. Your Responsibilities As part of a Blue Cross provider - performance consultation team, this role * Identifies opportunities for provider … more
