• Licensed Medicare Sales Representative…

    Wider Circle (Los Angeles, CA)
    …Scope of Appointment, the presentation of the product, sales conversion and relationship management of a Medicare beneficiary * Daily tasks include completing a ... a fast-growing boutique insurance agency focused on helping people understand their Medicare Benefits. We work with underserved populations to help them navigate … more
    Wider Circle (06/18/25)
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  • Medicare Product Development Manager,…

    Molina Healthcare (Layton, UT)
    …with the Service Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, ... **Job Summary** This position is responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other… more
    Molina Healthcare (07/25/25)
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  • Medical Director - National Medicare

    Humana (Olympia, WA)
    …radiology, and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in ... a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with national guidelines… more
    Humana (08/21/25)
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  • Non-Clinical Coding and OASIS Review Manager

    BAYADA Home Health Care (Orlando, FL)
    …for quality and adherence to policies and procedures. As a member of the Medicare Case Management (MCM) office, individuals in this role are expected to ... to the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each… more
    BAYADA Home Health Care (08/15/25)
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  • Director, Physician Leadership - Medical Directors…

    Humana (Carson City, NV)
    …team to assist and facilitate new hires and remediation of medical directors performing Medicare utilization management processes and be the liaison for the ... key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with...or nurse, with a focus on our 5+ million Medicare members. You will also facilitate the delivery of… more
    Humana (08/21/25)
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  • Utilization Management Nurse

    Actalent (Sunrise, FL)
    …Utilization management + InterQual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical record ... Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management...Milliman Criteria. + Knowledge of Florida Medicaid Program and CMS Guidelines. + Proficient in word processing software, spreadsheet… more
    Actalent (08/21/25)
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  • Director, Highly Integrated Dual Eligible Special…

    Corewell Health (Grand Rapids, MI)
    …leaders across the enterprise (eg, Medical Directors, Quality Improvement, Utilization Management , Care Management , Medicare Product Development, Claims, ... receiving LTSS. It also ensures that LTSS operations align with the integration of Medicare and Medicaid benefits under Michigan's HIDE SNP model, meeting CMS more
    Corewell Health (06/11/25)
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  • Manager, Provider Engagement - VBP…

    Centene Corporation (Queens, NY)
    …Oversee Medicare -specific VBP contracts, focusing on implementation, performance management , and education of provider partners regarding CMS -aligned models, ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
    Centene Corporation (07/09/25)
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  • Manager Case Management Long-term Care…

    Highmark Health (Dover, DE)
    …the department's case management processes. This includes utilization management , strategic planning, care cost initiatives, system development, compliance ... regulatory agencies including but not limited to: NCQA, URAC, CMS , DOH, and DOL. + Promote strict adherence to...+ 1 year in a home clinical or case management role + Medicare or Medicaid experience… more
    Highmark Health (06/27/25)
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  • Medicare MAP Advisor

    Centers Plan for Healthy Living (Staten Island, NY)
    …by explaining program benefits in a manner that is compliant with Center for Medicare and Medicaid Services ( CMS ) and company policies and regulations. The ... + AHIP certified + Computer/technology literacy + Compliant with CMS and CPHL policies. + Follow CPHL, CMS...CPHL sites located throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare more
    Centers Plan for Healthy Living (07/15/25)
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