• MDS Coordinator

    WMCHealth (Warwick, NY)
    …leadership and clinical assistance to all facility personnel to ensure facility compliance with Nursing Care Standards as applied to Resource Utilization Groups. The ... and appropriateness of placement + Assesses resident's potential eligibility for Medicare coverage. Initiates Medicare Certification and recertification for… more
    WMCHealth (09/12/25)
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  • Associate Actuary

    CenterWell (Columbus, OH)
    …Experience working in coding languages such as SAS and SQL + Prior Medicare Advantage or health insurance background + Additional skills developing reports and ... role provides a unique opportunity to get hands on Medicare Advantage experience in a rapidly growing area outside...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
    CenterWell (09/11/25)
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  • Broker Relationship Manager (CO)

    Humana (Denver, CO)
    …put health first** Are you passionate about contributing to the well-being of the Medicare population? Would you like to play an integral and strategic part in the ... Qualifications** + 2+ years of sales experience in the Medicare industry + Prior experience with public speaking and...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
    Humana (09/09/25)
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  • Care Coach (Transition/Custodial Prevention)

    Humana (Burlington, IA)
    …related field. + Two (2) years of prior experience working with Medicare and Medicaid recipients, long-term care services, Home and Community-Based Services (HCBS), ... Experience working with a Waiver Program. + Experience with Medicare & Medicaid recipients. + Experience working with complex...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
    Humana (09/08/25)
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  • Actuary; Risk Adjustment Finance

    Humana (Salt Lake City, UT)
    …and plays a critical part in forecasting risk scores and revenue for the Medicare Advantage Part D business. The successful candidate will lead efforts to model ... FSA or plus relevant advanced degree + Experience with Medicare Part D + Familiarity with Risk Score Data...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
    Humana (09/06/25)
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  • Senior Consumer Service Operations Professional

    Humana (Frankfort, KY)
    …working in healthcare industry + **2+ years experience with Employer/Group Medicare plans** + Extensive experience in a corporate service operations environment ... effectively manage multiple activities + Experience with medical claims + Medicare experience + Project Management experience **Address location for role:**… more
    Humana (09/06/25)
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  • Licensed Clinical Social Worker

    Somatus (Falls Church, VA)
    …notes involving mental health and risk assessments. + Adjusts treatment plans in compliance with changes in the status of the patient. + Provides information and ... + Educate patients on their insurance options including Group Health Plans (GHPs), Medicare , Medicaid, and managed care plans. Serve as a liaison between patients,… more
    Somatus (08/28/25)
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  • Executive Director, Chief Actuary

    Banner Health (Phoenix, AZ)
    …preparing and delivering reports and presentations, analyzing, developing, and/or submitting Medicare Advantage and Prescription Drug plan bid pricing tools and/or ... direct the preparation of rate filings to Centers for Medicare and Medicaid Services (CMS), Health and Human Services...are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved. 4.… more
    Banner Health (08/23/25)
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  • Provider Engagement Professional

    Humana (Indianapolis, IN)
    …costs, administrative expenses and quality/bonus performance + Comprehensive knowledge of Medicare policies, processes and procedures + DSNP experience inclusive of ... Medicare Advantage + Long-term support services; experience working with...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
    Humana (08/22/25)
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  • Regulatory Analyst

    Healthfirst (NY)
    …+ Performs first level review of all marketing materials to ensure compliance with State and Federal guidelines. + Prepares and submits marketing materials ... Provides support to all internal stakeholders during the annual Medicare Go to Market project in preparation for the... Go to Market project in preparation for the Medicare Annual Enrollment Period (AEP). + Contributes to the… more
    Healthfirst (08/21/25)
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