- Healthfirst (NY)
- …of material reviews in HPMS. + Actively participates in the annual Medicare Go to Market process, including working with internal stakeholders on developing ... deliverables as needed. + Assists in the preparation of Medicare Part C and D reporting via HPMS, including...knowledge of Microsoft Office Suite applications. + Knowledge of Medicare and CMS guidelines as it relates to member… more
- Molina Healthcare (Yonkers, NY)
- …PST hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving ... with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research… more
- Molina Healthcare (Albany, NY)
- …Affairs to assess and provide analyses for proposed changes to Medicare , and other government-sponsored healthcare program contracts, governing regulations and new ... 10 years' experience in Managed Care, specifically government programs and/or Medicare /Duals Health Plan Operations or equivalent combination of education and… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Medicare Wellness Registered Nurse will schedule and conduct Medicare Annual Wellness visits in Primary Care Offices. Provides professional ... required by the time of appointment. Preferred Qualifications: Experience with Medicare wellness visits and collaborating with a multi-disciplinary team. EPIC… more
- Humana (Albany, NY)
- …clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Molina Healthcare (Albany, NY)
- …related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with CMS CTM ... portal, SLA tracking, and program audits. * Deep knowledge of Medicare regulations affecting complaints, grievances, and member communications. * Exposure to… more
- Molina Healthcare (Yonkers, NY)
- …Enrollment activities (along with other Core Ops areas of responsibilities) within Medicare and Medicaid. Role is predicated on building relationships with vendors, ... the Service Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, including… more
- Staffing Solutions Organization (Albany, NY)
- …& Marketplace Integration (DEMI)** **Bureau of Third-Party Health Insurance, Medicare Savings Program and Recoveries** **Telecommuting Option:** This position is ... which may be received from a variety of sources such as Centers for Medicare and Medicaid Services (CMS), Insurance Carriers, and others. + Ability to problem solve… more
- Molina Healthcare (Syracuse, NY)
- …or special projects as required. + Must have experience working in Medicare + Must have experience analyzing claims. **Job Qualifications** **REQUIRED EDUCATION:** ... Associate's Degree and/or equivalent combination of education and Health Care related experience of 4+ years **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** 4+ years experience in health care industry in related field **PREFERRED EDUCATION:** Bachelor's… more
- Molina Healthcare (Buffalo, NY)
- …speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. + Ensures that adequate staffing coverage is ... present at all times of operation. + Assists pharmacy leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions. + Responsible for key performance indicators (KPI) reporting to… more