- Humana (Sacramento, CA)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare… more
- UCLA Health (Los Angeles, CA)
- …to develop, lead, and execute the organization's member experience strategy across all Medicare Advantage products. This role is critical to improving CMS Star ... development and execution of a comprehensive member experience strategy for Medicare Advantage products + Drive improvements in CMS Star Ratings through… more
- Highmark Health (Sacramento, CA)
- …knowledge to the team. They support the full-cycle ownership of commercial and Medicare Advantage medical policies, both developed internally and by vendors. ... as required. **ESSENTIAL RESPONSIBILITIES** + Full-cycle ownership of commercial and Medicare Advantage medical policy creation process including writing… more
- UCLA Health (Los Angeles, CA)
- …at UCLA Health by joining our team as a Compliance Auditor, MAPD, focused on Medicare Advantage (Part C) and Prescription Drug (Part D) programs. In this vital ... reviews, and more. * Design and improve audit toolkits based on Medicare Advantage and Part D risk areas. * Collaborate with stakeholders and leadership… more
- UCLA Health (Los Angeles, CA)
- Description Are you passionate about evidence-based medicine and improving care for Medicare Advantage members? UCLA Health Medicare Advantage Plan is ... 2 or more years of experience working managed care + Knowledge of Medicare Advantage experience with utilization management, quality improvement, or case… more
- Humana (Sacramento, CA)
- …the CFO team, which drives aggregate financial results and insights across primarily Individual Medicare Advantage (MA). This team serves as a central hub for ... focused on continuously improving consumer experiences **Preferred Qualifications** + Medicare Advantage pricing and forecasting experience + Experience… more
- Humana (Sacramento, CA)
- …the CFO team, which drives aggregate financial results and insights across primarily Individual Medicare Advantage (MA). This team serves as a central hub for ... filing, reporting & analysis, reserving or trending) **Preferred Qualifications** + Medicare Advantage pricing and forecasting experience + Experience working… more
- UCLA Health (Los Angeles, CA)
- …The NCQA and CMS Star Rating Program Manager will lead initiatives to drive the Medicare Advantage Plan's success in NCQA Health Plan Accreditation and CMS Star ... of NCQA survey process and IRT systems + Knowledge of Medicare Advantage operations, CMS regulations, and health services program requirements + Knowledge… more
- CenterWell (Sacramento, CA)
- …Direct experience working with Homecare Homebase strongly preferred. * Experience supporting Medicare , Medicare Advantage , Medicaid, and commercial payers. * ... methodologies. **Compliance & Risk Management** * Ensure compliance with Medicare , Medicaid, and commercial payer authorization and revalidation requirements. *… more
- UCLA Health (Los Angeles, CA)
- Description As a member of the Medicare Advantage Operations team, Business Data Analyst is instrumental in independently developing the detailed requirements ... + Minimum of five (5) years' experience in a Medicare or Managed Care environment managing enrollment, claims or...five (5) years' experience with CMS processes in a Medicare or Managed Care environment required + Experience with… more
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