- Humana (Atlanta, GA)
- …and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will ... rehabilitation **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid products, or other Medical… more
- Molina Healthcare (GA)
- …member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, ... a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines… more
- CVS Health (Atlanta, GA)
- …This position is accountable for the strategic alignment, operational success and performance management of Medicare Advantage Value-Based Contracts (VBC), ... independently to manage relationships and identify/implement solutions to problems + Drives provider performance and partners with local market to ensure… more
- Humana (Atlanta, GA)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... inpatient experience preferred** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
- Humana (Atlanta, GA)
- …Policies and Procedures, and clinical literature as appropriate. Medical Directors will learn Medicare Part D and Medicare Advantage requirements and will ... Director will collaborate with clinicians and support staff to provide Humana members with optimal value based care in...experience in a medical management review organization such as Medicare Advantage , managed Medicaid, or Commercial health… 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 ... grouping, with more than 2,000 physicians and approximately 70,000 Medicare fee-for-service beneficiaries. Additionally, DVACO currently holds performance -based… more
- Humana (Atlanta, GA)
- …growth strategy, leading the development of the annual Medicare Advantage strategic plan, monitoring segment-wide operational performance , and refreshing the ... Insurance segment's highest priority projects and initiatives, with an emphasis on Medicare Advantage strategy development. As a Senior Strategy Advancement… more
- Highmark Health (Atlanta, GA)
- …gain share and risk share models and will be implemented for the Organization's Medicare Advantage , Medicaid, ACA, and commercial populations with the goal of ... DE) and Enterprise Quality, Safety, and Values (Health Outcomes Measures). Provide actionable opportunities in provider transformation aimed at high-quality,… more
- Humana (Atlanta, GA)
- …US. At the core of this evolution is Humana's Insurance Segment, which provides Medicare Advantage , Medicaid, and other health plans to millions. By integrating ... of strategic initiatives and business areas, evolving key facets of the Medicare Advantage growth strategy, and identifying improvement opportunities for a key… 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