- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …This position manages administrative elements of the Companies' (LHSIC, HMOLA, and VHP) Medicare Advantage Compliance Program , including development and ... on Compliance objectives, projects, timelines, and deliverables for the Medicare Advantage Compliance Program . Create and maintain compliance… more
- Highmark Health (Charleston, WV)
- …are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with ... STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the needs… more
- UCLA Health (Los Angeles, CA)
- …relationship-building skills with clinical and non-clinical personnel + Knowledge of the Medicare Advantage STARS program and NCQA technical specifications ... at UCLA Health. As a key leader within our Medicare Advantage team, you will develop and...accuracy, efficiency, and adherence to all regulatory and CMS compliance requirements. You will manage the coding consultants who… more
- The Cigna Group (Columbus, OH)
- **Channel Marketing Director, Medicare Advantage - Hybrid** The Marketing Director will be responsible for leading the channel marketing team that supports the ... Cigna Medicare Advantage (MA) business. The MA business...the health insurance industry and a working knowledge of compliance requirements is desired. **Responsibilities** + Lead the development… more
- The Cigna Group (Atlanta, GA)
- **Marketing Advisor, DTC Advertising ( Medicare Advantage ) - Hybrid** Responsible for day-to-day management of direct-to-consumer advertising. Play a pivotal role ... with other channels, meet brand standards and can positively impact Cigna's Medicare Advantage growth goals. **Responsibilities** + Partner to provide the… 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 ... both internal stakeholders and external partners to ensure adherence to compliance requirements while optimizing costs. Salary Range: $146,900 - $371,300/annually… more
- The Cigna Group (Birmingham, AL)
- …group contracting and negotiations** + **Experience with Healthcare - Commercial and Medicare Advantage ** + Experience in developing and managing key provider ... to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance , Sales and Marketing and Service. + Manages strategic positioning… more
- CVS Health (Phoenix, AZ)
- …support for the elements and compliance department responsibilities required under the Medicare Compliance Program , which include but are not limited to ... Compliance position that supports the compliance program activities and deliverables of a Medicare ...and program policy related obligations as a Medicare Advantage organization + In partnership with… more
- MarketSource (Alpharetta, GA)
- …and lead the insurance compliance management strategy for the organization's Medicare Advantage sales program including carrier compliance , ... culture of insurance compliance awareness * Ensure compliance with regulatory obligations including Centers for Medicare...and may be subject to specific elections, plan, or program terms. This role may be eligible for the… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare Advantage Plan visibility in the community by monitoring multiple ... responsible for educating and enrolling potential beneficiaries by explaining program benefits in a manner that is compliant with...issued by Centers Plans for Healthy Living MAP and Advantage Care Medicare HMO Plan. Enrollment application… more
- Somatus (Mclean, VA)
- …Programs to optimize the programs' clinical benefit, financial accuracy and ensure program compliance with governing bodies' regulations, including the Center ... for risk score accuracy. + Responsible for the program to meet full compliance with state,...enrollment etc. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven… more
- Universal Health Services (Reno, NV)
- …organization to execute key initiatives for the effectiveness of the Compliance Program for health plan products, including Medicare Parts C and D, large- ... follow-up. The Compliance Analyst will support the Compliance Program to ensure compliance ... compliance ; experience with managed care organizations and Medicare Advantage preferred. + Experience with State… more
- Dartmouth Health (Lebanon, NH)
- …compliance regulations related to the First-Tier, Downstream and Related Entity (“FDR”) Medicare Compliance Program Guidance in collaboration with DH ... . The role will also administer oversight to comply with Medicare Advantage directed First-Tier Downstream Related Entity (FDR) compliance program .… more
- Universal Health Services (Reno, NV)
- …laws, regulations, policies and practices for the administration of Medicare Advantage , Prescription Drug Plan, and compliance programs in a managed care ... in 2014. Prominence Health serves members, physicians, and health systems across Medicare , Medicare Advantage , Accountable Care Organizations, and commercial… more
- Point32Health (Canton, MA)
- …at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Lead Compliance Program Manager will be responsible for development, ... well as external stakeholders including government regulators and auditors. The Lead Compliance Program Manager will be responsible for collaborating with… more
- Somatus (Mclean, VA)
- …The CCO is responsible for the ongoing development and periodic assessment of the Company's Compliance Program (The Program ). The Program must fulfill ... Essential Duties and Responsibilities The CCO establishes and implements an effective compliance program to prevent illegal, unethical or improper conduct. The… more
- Brockton Hospital (Brockton, MA)
- …responsible for assisting the Chief Compliance Officer (CCO) with the institutional compliance program planning and execution. The CCO performs or supports ... gaps in processes and where current activities can be leveraged for system-wide compliance program . Also, analyze data for errors and investigate variances. +… 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, ... 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) ... responsible for educating and enrolling potential beneficiaries by explaining program benefits in a manner that is compliant with...Territory Management + Maintain Centers Plans for Healthy Living Advantage Care Medicare HMO Plan visibility in… more
- BlueCross BlueShield of North Carolina (NC)
- …healthcare for all, + Deliver on optimal performance of the Medicare pharmacy program across Medicare Advantage , including DSNP. EGWP and the Medicare ... trend management, costs of care programs, quality programs and compliance , + Acquire and maintain top talent within the... Advantage , including DSNP, EGWP and the Medicare Prescription Drug Program (Part D) +… more