• Manager, Provider Engagement - VBP…

    Centene Corporation (Queens, NY)
    …is critical in managing end-to-end provider engagement, contract modeling, and performance oversight for Medicare Advantage and Dual Eligible Special ... + Oversee Medicare -specific VBP contracts, focusing on implementation, performance management, and education of provider partners regarding CMS-aligned… more
    Centene Corporation (07/09/25)
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  • Quality Program Manager - Medicare

    Providence (WA)
    **Description** **Quality Program Manager - Medicare Advantage Stars** **The Quality Program Manager - Medicare Advantage Stars is tasked with serving as ... Quality Program Manager will:** + Develop and implement strategies to improve Medicare Advantage Star Ratings, driving clinical quality indicators (HEDIS Star… more
    Providence (07/19/25)
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  • Senior Fraud Investigations Analyst…

    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 ... the business/organization. + In the course of investigation, may be required to provide deposition and/or testimony May also be required to conduct interviews of… more
    BlueCross BlueShield of North Carolina (07/25/25)
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  • Medicare Advantage Risk Adjustment…

    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 ... reports. + Write clear specifications and design data queries for healthcare performance measures. + Apply technical expertise to gather requirements and translate… more
    UCLA Health (06/11/25)
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  • Provider Engagement Analyst, VBP…

    Centene Corporation (Providence, RI)
    performance of Medicare -focused VBP arrangements across New York, including Medicare Advantage and Dual Eligible Special Needs Plans (D-SNPs). This role ... is critical in analyzing provider performance , modeling contract terms, and generating...organization drive population health improvements and financial sustainability through Medicare VBP strategies. + Partner with Contract management and… more
    Centene Corporation (07/23/25)
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  • Sr. Manager, Medicare Strategy & Business…

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …create monthly business review report that displays the key metrics of BCBSMA's Medicare Advantage business + Design and develop metrics, reports, and dashboards ... expense to suggest business improvements and efficiencies + Lead Medicare provider strategy workgroup by working with...We're Looking for : + Experience in Government Programs, Medicare Advantage Preferred + Ability to develop… more
    Blue Cross Blue Shield of Massachusetts (06/26/25)
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  • Medicare Risk Adjustment Strategy Program…

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …considerations and recommendations We're Looking for : + Excellent knowledge of Medicare Advantage risk adjustment programs and industry trends + Knowledge ... experience. + 6-8 years of relevant experience, preferably in health insurance + Medicare Advantage and Prescription Drug Plan experience a plus #LI-HYBRID… more
    Blue Cross Blue Shield of Massachusetts (06/27/25)
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  • Medicare Customer Satisfaction Advocate

    TEKsystems (Rochester, NY)
    …the job - Responsible for maintaining accurate and up-to-date knowledge of all Medicare Advantage regulations and possess the ability to communicate to members ... performance guidelines and standards set forth by the Medicare Division and the Centers for Medicare ...We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are… more
    TEKsystems (08/02/25)
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  • Senior Medicare Markets Pricing Consultant…

    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 ... work collaboratively with both technical and non-technical staff including Underwriting, Medicare Product Development, Provider Contracting, Sales, and others… more
    Blue Cross Blue Shield of Massachusetts (07/30/25)
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  • Medical Director - National Medicare

    Humana (Olympia, WA)
    …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand ... radiology, and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in… more
    Humana (07/21/25)
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