- CVS Health (Columbus, OH)
- …Summary** Leads the strategy, design, development and life cycle management of Aetna Medicare products that serve Medicare Advantage populations, including ... Direct product enhancements **Required Qualifications** 7+ years of experience with Medicare Advantage plans, including C- SNP plans. **Preferred… more
- UCLA Health (Los Angeles, CA)
- Description As the Business Data Analyst for our Medicare Advantage Risk Adjustment team, you will be responsible for producing accurate and insightful ... department measurements used in both internal and external reporting. You will: + Ensure data quality and accuracy through rigorous assurance checks. + Develop and maintain reports, from ad hoc requests to scheduled production reports. + Write clear… more
- Molina Healthcare (ID)
- …**Job Summary** Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will ... protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare Advantage Plan visibility in the community by monitoring multiple ... equipment issued by Centers Plans for Healthy Living MAP and Advantage Care Medicare HMO Plan. Enrollment application process + Ensures prospective members are… more
- BrightSpring Health Services (Knoxville, TN)
- …Business Signature Advantage , an affiliate of BrightSpring Health Services, is a Medicare Advantage Plan covering all the benefits of Original Medicare ... Our Company Signature Advantage Overview Seeking a Sales Account Representative/Executive for...and marketing presentations in accordance with applicable Centers for Medicare & Medicaid Services (CMS) and State guidelines and… more
- TEKsystems (Chesapeake, VA)
- …role is responsible for the compliant, accurate, and timely billing and follow-up of Medicare and Medicare Advantage patient accounts. The ideal candidate ... collaborate with internal teams to implement corrective actions. + Submit Medicare and Medicare Advantage claims (UB-04 and 1500), including shadow bills.… more
- Centene Corporation (Queens, NY)
- …in managing end-to-end provider engagement, contract modeling, and performance oversight for Medicare Advantage and Dual Eligible Special Needs Plans (D-SNPs). ... Act as a strategic advisor on contract structure and payment methodologies for Medicare Advantage and D-SNP providers, supporting new contract negotiations and… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …+ Solid understanding of Medicare and its related financial models, including Medicare FFS, Medicare Advantage , Medicare Part D, and ... exposure to all areas of BCBSMA, with a focus on senior product strategy and Medicare Markets. This candidate must be a creative thinker with the ability to drive… more
- Humana (Carson City, NV)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand ... and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in a medical… more
- Humana (Concord, NH)
- …and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will ... Qualifications** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid products, or other Medical management organizations,… more