- Humana (Columbus, OH)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other ... Utilization management experience in a medical management review organization, such as Medicare Advantage , managed Medicaid, or Commercial health insurance. +… more
- Humana (Columbus, OH)
- …data requests and perform valuations that help inform financial strategy related to the Medicare Advantage line of business. **Use your skills to make an ... organization focused on continuously improving consumer experiences **Preferred Qualifications** + Medicare Advantage experience + Finance background preferred +… more
- Datavant (Columbus, OH)
- …+ Keep up to date with current coding policies for ICD-10, Medicare Advantage , HHS (ACA), and other markets. + Provide guidance and make strategic ... or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience.… more
- Trinity Health (Columbus, OH)
- …(https://www.mcmg.mountcarmelhealth.com/) , a college of nursing (https://www.mccn.edu/) , a Medicare Advantage plan (https://www.medigold.com/) , and extensive ... executive-level summaries and reports related to peer review findings and provider performance . + Reviews peer review committee charters and policies and… more
- NASCO (Columbus, OH)
- …laws and regulations related to our products and services, including for our Medicare Advantage and ACA Exchanges business + Interacts with vendors and ... to identify and mitigate legal and business risks and provide practical solutions to complex issues to support our...compliance issues, including related to HIPAA + Experience supporting Medicare Advantage and ACA Exchanges business **Required… more
- Molina Healthcare (OH)
- …proficiency in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the ... Risk Adjustment submissions data to evaluate healthcare intervention program performance . Develops and presents Risk Adjustment intervention ROI, incremental… more
- Capgemini (Cincinnati, OH)
- …of **Program Manager / Sr Project Manager** - Markets and Growth portfolio Medicare Advantage / DSNP/ Medicaid or Exchange program/ product build knowledge ... (Enrollment, Eligibility, Claims, Provider network, encounters etc) (Highly Recommended having exposure to one or many functions) E2E set of Pharmacy Benefits… more
- Trinity Health (Columbus, OH)
- …(https://www.mcmg.mountcarmelhealth.com/) , a college of nursing (https://www.mccn.edu/) , a Medicare Advantage plan (https://www.medigold.com/) , and extensive ... Type:** Part time **Shift:** 12 Hour Day Shift **Description:** **Advance Practice Provide for Neurocritical Care, Casual / PRN** **Why Mount Carmel?** With five… more
- WTW (North Canton, OH)
- …a leading direct-to-consumer insurance services business, specializing in the distribution of Medicare Advantage , Medicare Supplement and Life & Supplemental ... professionals to deliver innovative solutions for our insurance carrier partners and provide consumers with a best-in-class experience. We work with some of… more
- Cleveland Clinic (Cleveland, OH)
- …or FSA - Associate Society of Actuary's or Fellow Society of Actuaries + Medicare advantage experience from an insurance company Our caregivers continue to ... At Cleveland Clinic, everyone is a caregiver supporting our mission to provide world-class patient care. Utilizes statistical and machine learning techniques, high-… more