• Senior Actuarial Analyst ( Medicare

    Molina Healthcare (Savannah, GA)
    **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. ... support executive decision-making. + Research and develop reports and analysis for senior management; effectively communicate results. + Assist in the preparation of… more
    Molina Healthcare (07/25/25)
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  • Senior Medical Director ( Medicare )

    Molina Healthcare (Macon, GA)
    …License without restrictions (free of sanctions from Medicaid or Medicare ) **PREFERRED EDUCATION:** Master's in Business Administration, Public Health, Healthcare ... Administration, etc. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Board Certification (Pediatrics, Family Practice, Ob/Gyn or Internal Medicine). **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting and temperature are adequate.… more
    Molina Healthcare (06/13/25)
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  • Senior Encounter Data Management…

    Humana (Atlanta, GA)
    …that result from the data exchange between Humana and its trading partners, Medicare and Medicaid. The Senior Encounter Data Management Professional will work ... of our caring community and help us put health first** The Senior Encounter Data Management Professional develops business processes to ensure successful submission… more
    Humana (08/15/25)
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  • Senior Manager, Product Mgt & Development…

    CVS Health (Atlanta, GA)
    …lifecycle management of Aetna's integrated products (HIDE/FIDE) that serve Medicare Advantage populations, including Dual-Eligible Special Needs Plans (D-SNP). This ... Center of Excellence, clinical, compliance, analytics and network teams, the Senior Manager drives innovation and operational excellence to optimize member… more
    CVS Health (09/05/25)
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  • Senior Analyst, Operational Regulatory…

    Molina Healthcare (Atlanta, GA)
    …any identified finding; Supports management with presenting results and recommendations to Senior Leadership and department staff. * Recommends new or updated job ... or special projects as required. + Must have experience working in Medicare + Must have experience analyzing claims. **Job Qualifications** **REQUIRED EDUCATION:**… more
    Molina Healthcare (08/22/25)
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  • Audit & Reimbursement Senior

    Elevance Health (Columbus, GA)
    …Medicaid Services to transform federal health programs. The **Audit and Reimbursement Senior ** will support our Medicare Administrative Contract (MAC) with the ... of Health and Human Services). The Audit and Reimbursement Senior will support contractual workload involving complex Medicare... Senior will support contractual workload involving complex Medicare cost reports and Medicare Part A… more
    Elevance Health (08/26/25)
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  • Director, Medicare Segment Optimization

    Molina Healthcare (Columbus, GA)
    **Job Description** **Job Summary** Leads and directs Molina Medicare segment leaders who are responsible for the development and administration of Medicare ... for assigned markets, including D-SNP market performance management. + Function as Medicare subject matter expert and point of contact for assigned market. +… more
    Molina Healthcare (09/07/25)
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  • AVP, Medicare Duals Optimization (Remote)

    Molina Healthcare (Augusta, GA)
    …and market leadership on mutual growth opportunities. + Works with senior management to mitigate risk and develop/implement improvements for all operational ... Affairs to assess and provide analyses for proposed changes to Medicare , and other government-sponsored healthcare program contracts, governing regulations and new… more
    Molina Healthcare (09/07/25)
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  • Director, Operational Oversight ( Medicare

    Molina Healthcare (Augusta, GA)
    …gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior individual contributor with the charter to build a focused CTM ... related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with CMS CTM… more
    Molina Healthcare (08/19/25)
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  • Program Director - Medicare Duals (Remote)

    Molina Healthcare (Macon, GA)
    …field of knowledge although they may have technical team members. Senior Program Management professional. Responsible for overall governance across all operational ... gaps and barriers in implementation and compliance to AVP, VP and senior management + Consultative role, develops business case methodologies for programs, develops… more
    Molina Healthcare (08/22/25)
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