- Molina Healthcare (Yonkers, NY)
- …with the Service Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, ... **Job Summary** This position is responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other… more
- Humana (Albany, NY)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience ... in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with national guidelines… more
- Humana (Albany, NY)
- …Programs Quality Strategy Lead will support Humana through successful participation in CMS /CMMI (Centers for Medicare and Medicaid Innovation) Multi-Payor and ... role supports Humana in assuming financial risk for Original Medicare beneficiaries through participation in CMS ' ...of Quality and/or HEDIS experience + 3+ years project management experience with mid to large scale projects +… more
- Cayuse Holdings (Albany, NY)
- …processes to ensure the HCMACS Program's Enterprise EHR Solution meets all Centers for Medicare & Medicaid Services ( CMS ) standards. This role involves acting as ... federal certification frameworks, and ensuring all deliverables, testing results, and system requirements meet established guidelines. The CMS Certification… more
- Centene Corporation (Queens, NY)
- …Oversee Medicare -specific VBP contracts, focusing on implementation, performance management , and education of provider partners regarding CMS -aligned models, ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …by explaining program benefits in a manner that is compliant with Center for Medicare and Medicaid Services ( CMS ) and company policies and regulations. The ... + AHIP certified + Computer/technology literacy + Compliant with CMS and CPHL policies. + Follow CPHL, CMS...CPHL sites located throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare … more
- Molina Healthcare (Albany, NY)
- …** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & ... issues, steer partners toward durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements.… more
- Humana (Albany, NY)
- …practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... by diverse resources which may include national clinical guidelines, CMS policies and determinations, Medicaid state contracts, clinical reference materials,… more
- Molina Healthcare (Rochester, NY)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with ... the standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of… more
- CVS Health (New York, NY)
- …teams to ensure consumer-facing language is streamlined and impactful, while compliant with CMS (Center for Medicare and Medicaid Services), Brand and Privacy ... and every day. **Position Summary** Within CVS Health, Aetna Medicare brings essential care to the nation's seniors and...regulations + Collaborate with Project Management , Marketing / Campaign Ops, Paid Media, and Digital… more