- Highmark Health (Charleston, WV)
- …in Medicare STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected ... or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for...a government program setting, managed care , primary care management or other clinical setting +… more
- CVS Health (Harrisburg, PA)
- …and affordable. Job Purpose and Summary: The Dental Director - Commercial and Medicare Advantage is an individual contributor who will assure that members ... care Primary Job Duties & Responsibilities: * Utilizes clinical experience and skills in a collaborative process to...knowledge of dental benefit products and platforms (DMO, PPO, Medicare Advantage ) + Strong understanding of value-based… more
- UCLA Health (Los Angeles, CA)
- …with clinical and non- clinical personnel + Knowledge of the Medicare Advantage STARS program and NCQA technical specifications + In-depth understanding ... at UCLA Health. As a key leader within our Medicare Advantage team, you will develop and...We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As a key member of our Medicare Advantage Operations team, you will partner with business and technical teams as well ... experience + Minimum of 5 years' experience in a Medicare or Managed Care environment managing enrollment,...We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of… more
- UCLA Health (Los Angeles, CA)
- …level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll provide direct management to a team of UM ... coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and...managerial experience required + Four or more years of clinical experience providing direct patient care +… more
- UCLA Health (Los Angeles, CA)
- …of Pharmacy Benefits Management! Reporting directly to the Chief Medical Officer of Medicare Advantage , you'll spearhead the development and oversight of our ... setting, required + Three or more years of Managed Care /PBM experience, highly desired + Two or more years...desired + Two or more years of experience in Medicare programs, preferred + Degree from an accredited school… more
- UCLA Health (Los Angeles, CA)
- …do all this and more at UCLA Health. As an important member of our Medicare Advantage team, you will provide strategic oversight and leadership for our Member ... improve patient experiences as part of a world-class health care team. Take your career in an exciting new...We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of… more
- The Cigna Group (Birmingham, AL)
- …group contracting and negotiations** + **Experience with Healthcare - Commercial and Medicare Advantage ** + Experience in developing and managing key provider ... and quality. + Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost… more
- UCLA Health (Los Angeles, CA)
- …a world-class, award-winning health system. Contribute to the delivery of award-winning patient care . Take your career in an exciting new direction. You can do all ... system with four award-winning hospitals and dozens of primary care practices, specialty practices, urgent care centers,...We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of… more
- Humana (Columbus, OH)
- …in genetics ortho or general surgery preferable** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements,...of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise… more
- Banner Health (WA)
- …Banner Plans & Networks Team, where your data analysis skills, quality assurance, and Medicare Advantage experience will be vital. You will use your background ... are built at Banner Health. There's more to health care than doctors and nurses. We support all staff...and report building to help us excel in our Medicare reporting and performance objectives. You will lead projects… more
- Somatus (Mclean, VA)
- …processing, customer service, enrollment etc. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven track record of ... Overview As the largest and leading value-based kidney care company, Somatus is empowering patients across the...+ Community engagement opportunities + And more! The Director, Medicare Risk Adjustment (MRA) will lead the execution strategy… 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.** Working under ... Ohio unrestricted license Technical Skills and Knowledge: + Strong clinical knowledge and understanding of health care ...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …Groups (DRGs), Prospective Payment Systems and Correct Coding Initiative + Experience in Medicare Advantage Plan, managed care or government contractor (eg: ... in support of proactive data analysis efforts. In addition, this position applies Medicare and Medicaid criteria guidelines in making clinical determinations as… more
- Highmark Health (Pittsburgh, PA)
- …processing arrangements including Federal Employee Program (FEP) and Medicare Advantage . **ESSENTIAL RESPONSIBILITIES** + Coordinates the clinical care ... team of talented Case Managers aims to individualize health care to meet each patient's specific needs with a...lieu of a degree. + 3 years in a clinical nursing role + Current State of PA RN… more
- VIP Care (Sarasota, FL)
- …hospital portal access, state licenses, and professional memberships + Ensure compliance with Medicare Advantage Plans, HIPAA, and labor laws and is responsible ... + Communicate with providers to ensure patient quality of care + Assists with scheduling, administrative, and clinical... care + Assists with scheduling, administrative, and clinical duties for providers (mid-levels and physicians) + Lead… more
- InnovaCare (San Juan, PR)
- …provider of healthcare management in North America. Through two it's main ways, Medicare Advantage and the provider network, we are committed to healthcare, ... complete the required annual trainings, may not perform his/her clinical duties and care management functions until...that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare … more
- Trinity Health (Grove City, OH)
- …(https://www.mcmg.mountcarmelhealth.com/) , a college of nursing (https://www.mccn.edu/) , a Medicare Advantage plan (https://www.medigold.com/) , and extensive ... and 133,000 colleagues nationwide. We know that exceptional patient care starts with taking care of our...Learn more at www.experiencecolumbus.com ! **About the job:** The Clinical Manager, under the direction of the Nurse Manager… more
- VIP Care (Estero, FL)
- …referral requests, patient records, and medication management + Ensures compliance with Medicare Advantage Plans, HIPAA, labor laws and is responsible for ... value of providing 5-star service that always puts patient care and outcomes first. You'll be part of a...them healthy. THE OPPORTUNITY VIPcare is searching for a Clinical Office Manager (CMA, RMA, MA) to provide preventative… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Clinical Consulting team, comprised of pharmacists and nurses, Pharmacy Product , Pharmacy Clinical Quality and Medicare Advantage + Attract, retain, and ... quality accreditation standards (eg HEDIS, NCQA) for all lines of business (Commercial, Medicare Advantage , Individual, HMO, FEP). + Develop and manage budget to… more