- Highmark Health (Phoenix, AZ)
- …knowledge to the team. They support the full-cycle ownership of commercial and Medicare Advantage medical policies, both developed internally and by vendors. ... as required. **ESSENTIAL RESPONSIBILITIES** + Full-cycle ownership of commercial and Medicare Advantage medical policy creation process including writing… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …data analysis. This roleleveragesdeepexpertiseinRiskAdjustment and healthcare data-primarily Medicare Advantage , Medicaid, and ACA Commercial-identifyingtrends ... have experience inRiskAdjustment methodologies, clinical coding, and healthcare programs ( Medicare Advantage , Medicaid, ACA Commercial), as well asproficiencyin… more
- UCLA Health (Los Angeles, CA)
- …at UCLA Health by joining our team as a Compliance Auditor, MAPD, focused on Medicare Advantage (Part C) and Prescription Drug (Part D) programs. In this vital ... reviews, and more. * Design and improve audit toolkits based on Medicare Advantage and Part D risk areas. * Collaborate with stakeholders and leadership… more
- UCLA Health (Los Angeles, CA)
- Description Are you passionate about evidence-based medicine and improving care for Medicare Advantage members? UCLA Health Medicare Advantage Plan is ... 2 or more years of experience working managed care + Knowledge of Medicare Advantage experience with utilization management, quality improvement, or case… more
- CenterWell (Frankfort, KY)
- …approval processes, financial reporting and maintaining market level sales materials for Medicare Advantage and ACO offerings + Develop and implement ... of eight year experience in Healthcare, with a specific focus on Medicare advantage with a history of effectively bringing together a myriad of stakeholders… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. **Under minimal ... insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans provide peace… more
- Humana (Frankfort, KY)
- … and Medicaid Services (CMS). The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures ... Qualifications** + Bachelor's Degree + 8+ years of experience in Medicare Advantage quality, Stars and/or member experience + Deep understanding of HEDIS… more
- Humana (Washington, DC)
- …US. At the core of this evolution is Humana's Insurance Segment, which provides Medicare Advantage , Medicaid, and other health plans to millions. By integrating ... of strategic initiatives and business areas, evolving key facets of the Medicare Advantage growth strategy, and identifying improvement opportunities for a… more
- Robert Half Accountemps (Philadelphia, PA)
- …terms, language, and Federal/State requirements. Familiarity with terms such as HMO, PPO, Medicare Advantage Plans, and Capitation, with a clear understanding of ... with medical billing forms, including UB04 and 1500. * Knowledge of Medicare Advantage Plans and Capitation processes. * Experience with CRM and ERP systems… more
- CVS Health (Hartford, CT)
- …Sponsor Liaison [PSL] will serve as the Single Point of Contact for Aetna Medicare Advantage servicing to our Plan Sponsors human resources personnel [their ... 50 miles of Hartford, Connecticut** + 3 years experience in Group Medicare Business and Medicare Advantage Plans and Products + Strong Leadership and… more