- Humana (Harrisburg, PA)
- …clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage ... authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which...and Managed Medicaid. + Utilization management experience in a medical management review organization, such as Medicare … more
- Humana (Harrisburg, PA)
- …materials, internal teaching conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and ... Medicare Advantage and Managed Medicaid products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other… more
- The Cigna Group (Philadelphia, PA)
- …team. The leadership and strategic direction you'll provide will better educate our Medicare clients on the products we offer and give their members' access to ... role, you will serve as the primary contact for Medicare strategic initiatives and market development. You will become...in a manner that allows for consultation, idea generation, compliance consulting, and strategic support. This person needs to… more
- CVS Health (Harrisburg, PA)
- …We are seeking a strategic and technically proficient leader to oversee Medicare data science initiatives supporting actuarial analytics and pricing. The ideal ... deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies. This...end-to-end bid cycle process, including pricing, forecasting, and regulatory compliance . + Serve as a subject matter expert on… more
- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse scope and...necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD… more
- Humana (Harrisburg, PA)
- …part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice ... appeals. The Corporate Medical Director works on problems of diverse scope and...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents… more
- Humana (Norristown, PA)
- …our caring community and help us put health first** Are you passionate about the Medicare population, looking for an opportunity to work in sales with the ability to ... as well as, visiting prospects in their homes. Our ** Medicare Sales Field Agents** sell individual health plan products...our consumers. **Humana Perks:** Full time associates enjoy + Medical , Dental, Vision and a variety of other supplemental… more
- CVS Health (Blue Bell, PA)
- …exciting and growing government business. The primary focus is the Medicare Advantage financial forecasting, reserving, and trend analysis. The colleague will ... actuarial support to ensure business strategies achieve optimal outcomes within the Medicare Advantage Markets. The colleague will work with business partners to… more
- CVS Health (Moon Township, PA)
- …or concerns. Maintains enrollment data in eligibility systems to ensure compliance with CMS guidance requirements. **Fundamental Components** + Meet Monthly Metrics ... skills. + Attention to detail and accuracy. **Preferred Qualifications** + Medicare industry experience. + Familiarity with Medicare Enrollment systems… more
- CVS Health (Blue Bell, PA)
- …a high-performing actuarial team supporting CVS Health and Aetna's Government Services Medicare Advantage business. The primary responsibility of this role will be ... identify and research problems and issues. + Demonstrate understanding of regulatory compliance issues. **Risk Analysis & Management:** + Work with supervisor to… more