- Cambia Health Solutions, Inc (Renton, WA)
- Provider Performance Director, Medicare Advantage (HEALTHCARE)Telecommute or Tele-Flex Options (Depending on location) - Must reside in ID, OR, UT or WAWHO ... Programs Provider Performance Director!Preferred Key Experience: Familiarity with Medicare Advantage and its business modelExperience at a provider… more
- 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 (Houston, TX)
- …All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: Growing ... **The Provider Performance Lead Analyst is a key member of...HEDIS, Risk Adjustment and medical expense reduction specific to Medicare Advantage required + Ability to apply… more
- BlueCross BlueShield of North Carolina (NC)
- …of go-to-market strategies. + Develop and maintain actuarial models to support the Medicare Advantage Part D bid process + Provide proactive and strategic ... thought leadership relating but not limited to pharmacy network , formulary, and Medicare Part D topics...such as competitive health benefits, bonus plans based on performance , 401(k) with employer match, paid time off (plus… more
- Healthfirst (New York, NY)
- …membership growth agent responsible for identifying, educating, and enrolling prospective Medicare Advantage (MA) beneficiaries in the appropriate MA plan ... The Medicare Outside Sales Representative is a top performing...the Delivery Services Engagement (DSE) team that works with in- network clinical providers to promote Healthfirst and ensure visibility,… 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...and partner requirements. + Drives industry best practices and performance results focusing on driving key KPI's (# visits,… 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
- Zelis (St. Petersburg, FL)
- …distinctive chance to craft top-tier recruitment strategies aligned with our expanding Medicare Advantage Network . Key Responsibilities + Identify, recruit, ... driven by a passion for achieving results in this performance -oriented role. Their primary responsibility involves securing signed contracts...strong network relations + Manage PPO and Medicare Advantage recruitment efforts and network… more
- CVS Health (Indianapolis, IN)
- …and parameters, or accuracy of provider contract or demographic information. Network Performance /Oversight . Recruits' providers as needed to ensure ... In-depth knowledge of managed care business, regulatory /legal requirements. . Medicare Advantage knowledge and experience Education Bachelor's degree… more
- CVS Health (Sacramento, CA)
- …Payment team, Capitation Analytics team, and Claim Operations. They will assist the Chief Network Officer and the Medicare Advantage General Manager, in ... capitation processes for market expansion, including the development of market level Medicare Advantage product and network strategies, and management… more
- The Cigna Group (Charlotte, NC)
- …Components** All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: + ... STARS, HEDIS, Risk Adjustment and medical expense reduction, preferably specific to Medicare Advantage + **Leadership:** 3+ years management experience required… 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
- 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
- Centers Plan for Healthy Living (Bronx, NY)
- …working weekends and requires frequent travel to various Centers Plans For 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
- Healthfirst (New York, NY)
- …using consultative selling/marketing. This role serves as the key player in educating Medicare Advantage and Medicaid Advantage Plus (MAP) benefits to ... This role serves as the key player in educating Medicare Advantage and Medicaid Advantage ...of products and services being discussed through varied techniques Performance Requirements + Develop and nurture relationships with prospective… more