- Highmark Health (Buffalo, NY)
- …are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with ... STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the needs… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare Advantage Plan visibility in the community by monitoring multiple ... equipment issued by Centers Plans for Healthy Living MAP and Advantage Care Medicare HMO Plan. Enrollment application process + Ensures prospective members are… more
- CVS Health (Albany, NY)
- …of medical costs management, compliance, and revenue integrity efforts for all Medicare Advantage products (inclusive of collaborating with the Employer Group ... every day. Aetna is recruiting for an AVP, General Manager who has Medicare market specific P&L accountability for the IVL/DSNP products in their market, supporting… more
- Humana (Albany, NY)
- …Policies and Procedures, and clinical literature as appropriate. Medical Directors will learn Medicare Part D and Medicare Advantage requirements and will ... Utilization management experience in a medical management review organization such as Medicare Advantage , managed Medicaid, or Commercial health insurance +… more
- Amazon (New York, NY)
- …will responsible primarily for several critical workstreams which include analysis of Medicare Advantage and Accountable Care Organization data, design and ... TME performance compared to plan expectations. Key job responsibilities -Analysis of Medicare Advantage and Accountable Care Organization data primarily -Medical… more
- Humana (Albany, NY)
- …internal teaching conferences, and other sources of expertise. 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
- University of Rochester (Brighton, NY)
- …Monetary Penalties, and + Medicare and Medicaid billing regulations (including CMS, Medicare Advantage and New York State Medicaid). + Manage disputes, risks ... and Compliance on relevant reimbursement and billing issues and requirements (including CMS, Medicare Advantage , and New York State Medicaid). Stays abreast of … more
- Humana (Albany, NY)
- …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicaid, and Medicare Advantage requirements and will ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
- Humana (Albany, NY)
- …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicare Advantage , and Medicaid requirements and will ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
- Humana (Albany, NY)
- …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand ... hours** **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more