- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Care Manger is responsible for facilitating care for members and ... health care disparities, social determinants of health, and any barriers to care . The Clinical Care Manger will engage members in appropriate plans of … more
- UCLA Health (Los Angeles, CA)
- …the integration and publishing of current and legacy sources of Medicare Advantage , managed care , clinical , revenue cycle, and other health system ... with a strong sense of urgency + Extensive healthcare industry knowledge, including Medicare Advantage , professional billing, and data analysis + Ability to… more
- 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
- 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
- Health First (Rockledge, FL)
- …or health plan compliance program operations specializing in Medicare Advantage *Licensure: *None *Certification: * Advanced health care compliance / ... or business field. *Work Experience: * Five years of health plans Medicare Advantage & Individual & Family plans, regulatory or compliance experience.… 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 The Director, Medicare Risk Adjustment (MRA) will lead the execution...the organization's Risk Adjustment Programs to optimize the programs' clinical benefit, financial accuracy and ensure program compliance with… 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 PA RN license +… 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
- 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
- VIP Care (Ocoee, 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
- 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
- Trinity Health (Westerville, OH)
- …(https://www.mcmg.mountcarmelhealth.com/) , a college of nursing (https://www.mccn.edu) , a Medicare Advantage plan (https://www.medigold.com) , and extensive ... 22 states, 94 hospitals, and 133,000 colleagues nationwide. We know that exceptional patient care starts with taking care of our colleagues, so we invest in… 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
- Medical Mutual of Ohio (Brooklyn, OH)
- …including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. The Clinical Operational Excellence Director Serves ... unit's leadership team. *Master's degree in business or health care administration, finance, or related field. In lieu of...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and… 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