• Behavioral Health Medical Director…

    Humana (Concord, NH)
    …on quality management, utilization management, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation ... teaching conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , ...quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will… more
    Humana (08/09/25)
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  • Actuary - Medicare Part D - Evernorth…

    The Cigna Group (Bloomfield, CT)
    …assumptions for Regulated Medicare Part D Health Plans + Create analytics for Medicare Part D Bids substantiation for Desk Review and Medicare Part D ... studies to aid in identification of gaps in the Medicare Part D Prescription Drug Health market...not limited to: + Part D Bid Development, Desk Review & Audits + CMS Regulatory Compliance / Reporting… more
    The Cigna Group (08/04/25)
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  • Medical Director - Medicare Appeals

    CVS Health (Hartford, CT)
    …ABMS or AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan ... At CVS Health , we're building a world of health...resources. * This is a remote based (work at home ) based anywhere in the US. Responsibilities of this… more
    CVS Health (07/30/25)
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  • Actuary - Medicare Duals

    Centene Corporation (Charleston, WV)
    …one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national ... Centene is seeking a motivated, experienced, and self-driven actuary to join our ** Medicare Duals** team. This role offers a unique opportunity to contribute to… more
    Centene Corporation (07/31/25)
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  • Medicare Sales Field Agent - CarePlus…

    Humana (Palm Bay, FL)
    **Become a part of our caring community and help us put health first** Are you passionate about the Medicare population, looking for an opportunity to work in ... our consumers. **_Face to face interactions in prospective members' home are a requirement for this position._** **Use your...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over… more
    Humana (07/30/25)
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  • Senior Medicare Coverage Analyst

    Actalent (Boston, MA)
    …protocol issues, and prioritize urgent amendments. Responsibilities + Train junior staff and review their work for accuracy in Medicare coverage analysis. + Act ... Senior Medicare Coverage Analyst As a Senior Medicare ...you to work from the comfort of your own home . You will be part of the Research Finance department,… more
    Actalent (08/08/25)
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  • Senior Medicare Communications Compliance…

    Centene Corporation (Cheyenne, WY)
    … materials and sales compliance. Participates in the ongoing oversight, analysis, review , and approval of all beneficiary-facing Medicare materials. In addition, ... , summarization and dissemination of key regulatory updates and changes with the Medicare Marketing Guidelines and relevance on material review . + Provides… more
    Centene Corporation (08/14/25)
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  • Senior Medicaid & Medicare Reimbursement…

    OhioHealth (Columbus, OH)
    …Clinics. Knowledge of reimbursement in specialty areas such psych, inpatient rehabilitation units, Home Health and Hospice. Projects as assigned by Director of ... **We are more than a health system. We are a belief system.** We...This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities.… more
    OhioHealth (06/07/25)
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  • Medicare Communications Compliance…

    Centene Corporation (Cheyenne, WY)
    Medicare materials and sales compliance. Participates the ongoing oversight, analysis, review , and approval of all beneficiary-facing Medicare materials. + ... this job have the flexibility to work remote from home anywhere in the Continental United States​.** **Position Purpose:**...years of experience in Managed Care/ Health Insurance/Public Health / Health Care Administration/ Medicare Part… more
    Centene Corporation (08/16/25)
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  • Medicare Specialist

    HCA Healthcare (Nashville, TN)
    …you find this opportunity compelling, we encourage you to apply for our Medicare Specialist opening. We promptly review all applications. Highly qualified ... individual is recognized. Submit your application for the opportunity below: Medicare SpecialistParallon **Benefits** Parallon, offers a total rewards package that… more
    HCA Healthcare (08/15/25)
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