- 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
- 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
- SUNY Upstate Medical University (Syracuse, NY)
- …Medicare Annual Wellness Visit using established EMR reports. Schedule and conduct Medicare Annual Wellness Visits in accordance with CMS guidelines. Perform ... Nurse (RN), or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) across seven Primary Care clinics. This role… more