- Trinity Health (Columbus, OH)
- …position until 4/4/2026 **Why MediGold?** MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and ... in accordance with the rules and regulations of a Medicare Advantage plan and governing agencies. Implements...Medicare and Medicaid Services (CMS), Ohio Department of Insurance (ODI), NCQA and all applicable Federal regulations. +… more
- Humana (Lansing, MI)
- …experience in a medical management review organization, such as Medicare Advantage , managed Medicaid, or Commercial health insurance . + Experience with ... internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand… more
- CenterWell (Columbus, OH)
- …+ Experience working in coding languages such as SAS and SQL + Prior Medicare Advantage or health insurance background + Additional skills developing ... **Additional Information** + This role provides a unique opportunity to get hands on Medicare Advantage experience in a rapidly growing area outside of bid… more
- Trinity Health (Columbus, OH)
- …is to end 04/04/2026 **Why MediGold?** MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and other ... Medicare beneficiaries across the United States. We're dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information… more
- Providence (OR)
- **Description** **Quality Program Manager - Health Plan Medicare Advantage Stars** **_Remote_** **The Quality Program Manager - Health Plan Medicare ... best-practice interventions that result in improved Star ratings.** **The Health Plan Medicare Advantage Stars Quality Program Manager will:** + Develop and… more
- Highmark Health (Charleston, WV)
- …are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with ... STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the needs… more
- BlueCross BlueShield of North Carolina (NC)
- …of degree, 7+ years of experience in related field **Bonus Points** + Deep Medicare and/or Medicare Advantage regulatory experience + Extensive Medicare ... care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We're committed to better health and better health… more
- Centene Corporation (Charleston, WV)
- …estimate outcomes. **In this Sr. Actuarial Analyst role, you will:** + Support ** Medicare Advantage bid development** , including preparing and reviewing PBP and ... with determining the equitable basis for distributing money for insurance benefits + Performs other duties as assigned +...Role Stands Out:** + **High-Impact Work** : Lead critical Medicare Advantage bid initiatives with visibility across… more
- Ochsner Health (New Orleans, LA)
- …care and public programs such as those funded by Medicare , Medicaid, Medicare Advantage , and commercial insurance plans. **Job Duties** * Interviews ... and assesses patients and assists throughout patient care plan. * Identifies and provides helpful resources to patients and families. * Maintains patient records and documents and communicates critical information to the medical team. * Participates in on-call… more
- Ochsner Health (New Orleans, LA)
- …systems and public programs such as those funded by Medicare , Medicaid, Medicare Advantage , and commercial insurance plans. + Strong interpersonal skills ... necessary to deal effectively and courteously with patients, families, multidisciplinary team members, departmental peers, and community agency personnel. **Job Duties** + Conducts patient assessment interviews, provides referrals and coordinates discharge… more