- Humana (Oklahoma City, OK)
- … STARS Improvement develops, implements, and manages oversight of the company's Medicare /Medicaid Stars Program. Directs all STARS quality improvement ... value providers + Collaborate with Provider Engagement, Provider Development, Medicare Risk Adjustment, and the Corporate Stars ...related field + 2 or more years of management experience + Knowledge of HEDIS/ Stars and CMS… more
- Humana (Pittsburgh, PA)
- …us put health first** Humana's Stars Improvement team is seeking a Senior Stars Improvement Professional with Medicare experience to work remote in ... and manage processes as part of the Northeast Region Medicare Stars Improvement Program. In this role,...+ **Must live in PA or MD** + Prior Medicare experience + Provider engagement/education, risk adjustment… more
- CVS Health (Moon Township, PA)
- …This position will be focused primarily on supporting our on-going collaboration with the Stars Member Experience team and supporting the expansion of ... the consumer at the center of their care. Aetna's Medicare Stars Team is growing and expanding!...collection of Member Survey Data, transforming that data, and loading into… more
- CVS Health (Richmond, VA)
- …or auditing programs + 1-3 years Medicare managed care experience + Experience with Medicare STARS and Part D Formulary benefits + Knowledge of ... other clinical programs + Communicate to providers, pharmacies, and members on quality, STARs , or FWA indicators for Medicare programs + Provide clinical… more
- LA Care Health Plan (Los Angeles, CA)
- …of business. Experience in improving Stars and Quality Measures. Experience in Medicare Advantage, with experience serving duals population. Direct ... operational processes that impact quality scores, enrollment, revenue and member retention. Design appropriate mitigation and contingency plans. Lead... experience in Medicare and Duals program administration including stars ,… more
- The Cigna Group (Baltimore, MD)
- …the assigned **(Mid-Atlantic (MD, DC & VA) region** as evidenced by physician and member satisfaction, improvements on Stars and NPS score. + Managing our Costs: ... The Provider Performance External Representative is a key member of the market that assists in the...direct provider-facing experience or direct health plan experience with STARS , HEDIS, Risk Adjustment and… more
- LA Care Health Plan (Los Angeles, CA)
- …with experience serving duals population. Direct experience in Medicare and Duals program administration including stars , quality, financial performance ... Product Solutions Manager II ( Medicare ) Job Category: Administrative, HR, Business Professionals Department:...and specific strategic initiatives in support of optimizing the member experience while managing the ongoing evolution… more
- The Cigna Group (Tucson, AZ)
- …2+ years' experience in customer service, claims, and/or payor related experience + Demonstrated knowledge of contracting process, Medicare fee schedules, ... Pima County based - Medicare Provider Performance Enablement (PPE) Senior Analyst provides...key program performance metrics, such as utilization, coding, and STARs /quality performance + Assist in the STARS … more
- Elevance Health (Richmond, VA)
- Wellpoint, formerly Amerigroup, is a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide ... Cost of Care, trend management, value-based care support for STARS /HEDIS and correct coding initiatives with providers as well...the US. + Minimum of 10 years of clinical experience ; or any combination of education and experience… more
- Humana (Columbus, OH)
- … in Employer Group Trend, Clinical Trend, Pharmacy Trend, Retail Trend or STARS + Project/Program management experience **Additional Information** To ensure Home ... help us put health first** The Medical Cost Strategist provides support to Medicare Medical Cost Management in the delivery of enterprise trend savings goals. Come… more
- Humana (Tallahassee, FL)
- …without limitations or assistance. See Additional Information on testing + 5 or more years of Medicare experience working in a Health Plan + 3 or more years of ... responsible for the development, implementation and management oversight of the company's Medicare /Medicaid Stars Program. The Senior Stars Improvement,… more
- Health First (Rockledge, FL)
- …to accrediting and regulatory agency inquiries and audit requests including CMS, Medicare Stars , NCQA, and any other regulatory requirements. 7. Facilitate ... strategic plans to support population health goals and initiatives to meet member needs across the continuum of care, including Integrated Care Program clinics.… more
- Humana (Tallahassee, FL)
- …Team level + Ability to maintain high engagement level **Role Desirables:** + Medicare product experience + Previous Provider Engagement experience + ... Pharmacy Lead is a key stakeholder to Pharmacy and Medicare Retail organization leadership in the management of Value...providers on numerous pharmacy topics. The collective teams support Stars , MRA and Provider Engagement teams by serving as… more
- CVS Health (Hartford, CT)
- …Medicare , Medicaid, IFP, Duals). This leader will focus on HEDIS Hybrid, STARS , Performance Improvement Plans, provider & member enablement, regulatory and ... experience in healthcare/managed care leadership roles with experience in HEDIS/Medicaid/ Medicare /Duals/IFP Quality program performance management,… more
- Insight Global (Woonsocket, RI)
- …client of ours. They will be part of the Informatics team with Aetna, focusing on Medicare stars applications called stars central. It focuses in on Tableau ... age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected...of SQL Server experience required. * Cloud experience (Azure of GCP) * Health insurance, Medicare… more
- CareOregon (Portland, OR)
- …analytics experience (including Tableau and SQL) Preferred + Strong understanding of Medicare Stars and other Medicare metrics Knowledge, Skills and ... relevant compliance needs. + Perform other duties as needed. Experience and/or Education Required + Minimum 4 years' ...Knowledge of healthcare quality metrics (eg CCO incentive measures, Medicare Stars measures, HEDIS or other measure… more
- CVS Health (Hartford, CT)
- …#GRS Group Retiree Solutions (GRS) is a core component of the Aetna Medicare Organization. Our vision is to develop an industry-leading group retiree health care ... sponsors and their members. We aspire to provide personalized, member -centric care that treats retirees like human beings during...team. This position is a key driver of additional Medicare Group Retiree growth opportunities as we partner with… more
- Universal Health Services (Reno, NV)
- …+ At least 5 years of health care experience working with value based Medicare Advantage STARS /HEDIS programs. + At least 3 years of health care ... tools that will result in leveraging information to manage member analytics in order to more effectively direct resources...experience working with Medicare and/or Commercial risk… more
- The Cigna Group (Seattle, WA)
- …of services in the assigned **Seattle, WA territory** as evidenced by physician and member satisfaction, improvements on Stars and NPS score. Managing our Costs ... **Role Summary:** The Provider Performance Lead Analyst is a key member of the market that assists in the growth and development of the provider network. The Lead… more
- Humana (Columbus, OH)
- …operational improvements and other areas as they relate to provider performance, member experience , market growth, provider experience and operational ... of a cross-functional, collaborative organization which includes Provider Service Experience , Network Optimization, Clinical Services, Value-Based contracting, HEDIS and… more