- Highmark Health (Charleston, WV)
- …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
- The Cigna Group (Baltimore, MD)
- …Components** All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: + ... The Provider Performance External Representative is a key member of...HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage required + Required - Microsoft… more
- BayCare Health System (Clearwater, FL)
- …of BayCare Health Plans and are responsible for prospecting and selling BayCarePlus Medicare Advantage plans to our Medicare community. + Responsibilities ... the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute...amazing team and a great place to work! BayCarePlus Medicare Advantage Plans **Facility:** BayCare Health System,… more
- Somatus (Mclean, VA)
- …processing, customer service, enrollment etc. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven track record of ... mental well-being + Community engagement opportunities + And more! The Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …in supporting the contracting regions with quality, utilization, and cost analysis. **Provider Network Performance Analyst I** + Gathers and maintains data from ... contracting initiatives. + Performs other duties as assigned. **Provider Network Performance Analyst II** + Conducts quality...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and… more
- Universal Health Services (Reno, NV)
- …in 2014. Prominence Health serves members, physicians, and health systems across Medicare , Medicare Advantage , Accountable Care Organizations, and commercial ... preferred. + Ability to develop and implement strategic initiatives. + Knowledge of Medicare Advantage and ACA risk scores and ability to educate providers… more
- CVS Health (Harrisburg, PA)
- …will be to continue to build and maintain our existing PPO, Extend, DMO and Medicare Advantage networks in a specific geographic area + Explaining the value in ... We're expanding in multiple directions and looking for innovative network recruiters to join our dental team. Innovation is...+ Dental industry knowledge + Knowledge of PPO and Medicare advantage methodologies + Salesforce experience Education… more
- InnovaCare (San Juan, PR)
- …the leading provider of healthcare management in North America. Through two it's main ways, Medicare Advantage and the provider network , we are committed to ... to serves as primary liaison between enrolled beneficiaries, provider network and MMM & MSO, for the purposes of...that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare … more
- InnovaCare (Ponce, PR)
- …the leading provider of healthcare management in North America. Through two it's main ways, Medicare Advantage and the provider network , we are committed to ... a conglomerate of companies that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare y Mucho Mas (MMM),… more
- InnovaCare (Guaynabo, PR)
- …the leading provider of healthcare management in North America. Through two it's main ways, Medicare Advantage and the provider network , we are committed to ... a conglomerate of companies that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare y Mucho Mas (MMM),… more
- InnovaCare (San Juan, PR)
- …the leading provider of healthcare management in North America. Through two it's main ways, Medicare Advantage and the provider network , we are committed to ... a conglomerate of companies that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare y Mucho Mas (MMM),… more
- Cleveland Clinic (Cleveland, OH)
- …quality, cost, and utilization data preferred. + Knowledge of ACO, Medicaid, and Medicare Advantage quality measures, NCQA and HEDIS standards, and Medicare ... \#LI-WG1 #LI-REMOTE Keywords: Value Based Care, Value Based Contracts, Value Based Performance , Value Based Program, Medicaid, Medicare , Population Health Pay… more
- InnovaCare (Guayama, PR)
- …the leading provider of healthcare management in North America. Through two it's main ways, Medicare Advantage and the provider network , we are committed to ... a conglomerate of companies that work on Puerto Rico's business strategies, both for Medicare Advantage beneficiaries, through Medicare y Mucho Mas (MMM),… more
- Centers Plan for Healthy Living (Bronx, NY)
- …working weekends and requires frequent travel to various Centers Plans or Healthy Living Advantage Care Medicare HMO Plan sites located throughout the five (5) ... boroughs. Territory Management + Maintain Centers Plans for Healthy Living Advantage Care Medicare HMO Plan visibility in the community by monitoring multiple… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. **Responsibilities** ... Measures accuracy of projections. . Analyzes effectiveness of provider network performance through financial modeling, network...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans.** **Responsibilities** ... to moderately complex financial analysis. Maintains market intelligence and analyzes network performance to provide Provider Engagement with consultative and… more
- The Cigna Group (Atlanta, GA)
- …All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: **Growing ... Senior Manager or Director, this individual ensures the effective performance management of the provider network for...the effective performance management of the provider network for his/her assigned sub-market and/or provider groups. The… more
- The Cigna Group (Seattle, WA)
- …All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: Growing ... **Role Summary:** The Provider Performance Lead Analyst is a key member of...assists in the growth and development of the provider network . The Lead Analyst is the primary conduit to… more
- Healthfirst (Enfield, NY)
- …business using consultative selling/marketing. This role serves as thekey player in educating Medicare Advantage and Medicaid Advantage Plus (MAP) benefits ... hospitals, community partners, and current business partners. Must generate referrals to the Medicare Advantage and Medicaid Advantage Plus (MAP) plans to… more
- Universal Health Services (Reno, NV)
- …in 2014. Prominence Health serves members, physicians, and health systems across Medicare , Medicare Advantage , Accountable Care Organizations, and commercial ... (UHS) has built an impressive record of achievement and performance . During the year, UHS was again recognized as...health care compliance; experience with managed care organizations and Medicare Advantage preferred. + Experience with State… more