- CVS Health (Atlanta, GA)
- …a high-performing actuarial team supporting CVS Health and Aetna's Government Services Medicare Advantage business. The primary responsibility of this role will ... experience. Should be at/near ASA (Associates of the Society of Actuaries) Medicare experience is desired (not required) Strong communication skills and excellent… more
- Molina Healthcare (Macon, GA)
- …**Job Summary** Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will ... protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by… more
- CVS Health (Atlanta, GA)
- …The ideal candidate will have deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies. This role requires a ... + Lead the development and execution of actuarial analytics strategies for Medicare Advantage and Part D programs. + Inform and enhance the end-to-end bid… more
- Humana (Atlanta, GA)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand ... and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in a medical… more
- Elevance Health (Columbus, GA)
- …not limited to: + Analyzes and develops SAS and SQL programming to support Medicare Advantage risk adjustment initiatives. + Performs data mining and data-driven ... ** Medicare Risk Adjustment Advanced Analytics Analyst** **On-Site Requirement:...an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics Analyst** is responsible for… more
- Humana (Atlanta, GA)
- …and allows you to see the overall end to end bid process at a leading Medicare Advantage organization. This is a great role for a collaborative individual who is ... may include monitoring and researching laws and regulations applicable to Medicare Advantage and actuarial science. Advises certifying actuaries, executives… more
- Humana (Atlanta, GA)
- …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
- Humana (Atlanta, GA)
- …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
- Humana (Atlanta, GA)
- …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
- Humana (Atlanta, GA)
- …Medicaid Services' Medicare Shared Savings Program (MSSP), plus other commercial and Medicare Advantage value based programs. DVACO is a joint venture among ... areas including HR. DVACO's MSSP participation accounts for the region's largest Medicare ACO grouping, with more than 2,000 physicians and approximately 70,000 … more