- Centene Corporation (Queens, NY)
- …is critical in managing end-to-end provider engagement, contract modeling, and performance oversight for Medicare Advantage and Dual Eligible Special ... + Oversee Medicare -specific VBP contracts, focusing on implementation, performance management, and education of provider partners regarding CMS-aligned… more
- CVS Health (Albany, NY)
- …do it all with heart, each and every day. **Position Summary** The Medicare Performance Management Lead Business Consultant will facilitate and support ... process and operating model. This role will assist the Medicare Advantage market facing General Manager most...for success. Role will report to the Head of Medicare Performance Management. **Fundamental Job Components:** +… more
- Humana (Albany, NY)
- …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
- Humana (Albany, NY)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand ... radiology, and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in… more
- Molina Healthcare (New York, NY)
- …member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, ... Provider Services. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of… more
- Molina Healthcare (NY)
- …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
- Centers Plan for Healthy Living (Staten Island, NY)
- …working weekends and requires frequent travel to various Centers Plans or Healthy Living Advantage Care Medicare HMO Plan sites located throughout the five (5) ... boroughs. Territory Management + Maintain Centers Plans for Healthy Living Advantage Care Medicare HMO Plan visibility in the community by monitoring multiple… 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 ... 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 (Albany, NY)
- …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
- New York State Civil Service (Queens Village, NY)
- …be terminated from your employment.If appointed, you may be required to become an enrolled Medicare provider ; obtain and provide to your employer a National ... approve leave and track time and attendance; and complete performance evaluations. * Functions as a member of an...Comprehensive Adult Transitional Home if required, when the assigned provider is not available.* Provide medical expertise… more