- Bon Secours Mercy Health (Cincinnati, OH)
- …work. This Population Health Clinical Quality Manager will support the Medicare Shared Savings Program (MSSP) value-based care model. **Primary Function/General ... provider (MSSP), National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), Healthcare Effectiveness Data and Information Set… more
- Humana (Olympia, WA)
- …established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Humana (Topeka, KS)
- …clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Commonwealth Care Alliance (Boston, MA)
- …and federal healthcare regulations, particularly MassHealth (Massachusetts Medicaid) and CMS Medicare requirements. This role is housed within the Claims Operations ... have): * Strong working knowledge of MassHealth ACO/MCO requirements and CMS ( Medicare Advantage) regulations. * Expertise in 42 CFR Part 422, MassHealth provider… more
- Molina Healthcare (Dallas, TX)
- …Effectively uses current and emerging technologies. This position will be focused on Medicare Stars requirements and data review. Please make sure to include your ... EDUCATION:** Bachelor's Degree or equivalent combination of education and experience Medicare Stars experience **PREFERRED EXPERIENCE:** 7-9 years To all current… more
- Staffing Solutions Organization (Albany, NY)
- …& Marketplace Integration (DEMI)** **Bureau of Third-Party Health Insurance, Medicare Savings Program and Recoveries** **Telecommuting Option:** This position is ... which may be received from a variety of sources such as Centers for Medicare and Medicaid Services (CMS), Insurance Carriers, and others. + Ability to problem solve… more
- Molina Healthcare (Idaho Falls, ID)
- …: 5-7 years national sales leadership in roles of increasing responsibility Medicare Advantage sales and Marketplace/ACA sales leadership roles Health plan sales ... management experience Demonstrated skills in process improvement and project management Leadership responsibilities for teams of 50+ FTEs **PREFERRED EDUCATION** : Graduate degree To all current Molina employees: If you are interested in applying for this… more
- Centene Corporation (Cheyenne, WY)
- …Complies with all policies and standards The Actuarial Intern will support the Medicare Actuarial team. The internship will allow the selected students to learn ... actuarial concepts including forecasting, assumption building, reserving and modeling. Interns who are working towards an actuarial designation will gain hands-on actuarial experience on assumption-setting and modeling. As an Actuarial Services Intern, you… more
- Guidehouse (Lewisville, TX)
- …from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & CMS ... 1500 + Complete all business-related requests and correspondence from patients and insurance companies. + Responsible for working on 40-70 Accounts Per Day + Complete all assigned projects in a timely manner. + Assist client and patients in all requested… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and Blue Shield of Minnesota Position Title: Behavioral Health Case Manager - Medicare Advantage Location: Remote Career Area: Health Services About Blue Cross and ... Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a… more