- 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
- The Cigna Group (Bloomfield, CT)
- …position will provide external actuarial analytics support within the regulated Medicare market and Pharmacy Benefit Manager (PBM) Healthplan space. This actuarial ... to provide a designated full time support to Express-Script's external client's Medicare Part D business. This role will matrix with internal leadership within… more
- 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
- CVS Health (Boston, MA)
- …candidate will have deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management , and pricing strategies. This role requires a strong ... Experience, preferably in the Healthcare Industry. + 5+ years of experience in Medicare Advantage actuarial pricing, bid development, and CMS Part C/D… more
- Molina Healthcare (Albany, NY)
- …** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & ... issues, steer partners toward durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements.… more
- Wider Circle (Newark, NJ)
- …dynamic boutique insurance agency that's transforming the way people navigate their Medicare benefits! At Ask Claire, we are passionate about empowering underserved ... in people's lives while growing your career in a thriving, impactful organization. Medicare Sales Representative At Ask Claire, a subsidiary of Wider Circle, we… more
- Prime Therapeutics (Oklahoma City, OK)
- …our passion and drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs - Remote, Pennsylvania **Job Description** Manages the ... coordination of benefits in the pharmacy program with Medicare Part D plans. Provides the technical and leadership...that have impacts on members, providers, Part D plans, CMS , and the company. Requires a working knowledge of… more
- Centene Corporation (Providence, RI)
- …the organization drive population health improvements and financial sustainability through Medicare VBP strategies. + Partner with Contract management and ... improvement or innovation in VBP strategies. + Assist in building and refining Medicare contract models, incorporating CMS and NYSDOH guidelines related to risk… more
- 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
- Providence (WA)
- …clinical quality (Stars HEDIS) measures, CAHPS, HOS + Deep understanding of the Medicare Advantage Stars program, CMS Star Rating Technical Notes, HPMS memos, ... **Description** **Quality Program Manager - Medicare Advantage Stars** **The Quality Program Manager -...Expert (SME) who is experienced at using Stars data, CMS Star Rating Technical Notes and HPMS memos to… more