- Humana (Concord, NH)
- …on quality management, utilization management, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation ... teaching conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , ...quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will… more
- The Cigna Group (Bloomfield, CT)
- …assumptions for Regulated Medicare Part D Health Plans + Create analytics for Medicare Part D Bids substantiation for Desk Review and Medicare Part D ... studies to aid in identification of gaps in the Medicare Part D Prescription Drug Health market...not limited to: + Part D Bid Development, Desk Review & Audits + CMS Regulatory Compliance / Reporting… more
- CVS Health (Hartford, CT)
- …ABMS or AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan ... At CVS Health , we're building a world of health...resources. * This is a remote based (work at home ) based anywhere in the US. Responsibilities of this… more
- Centene Corporation (Charleston, WV)
- …one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national ... Centene is seeking a motivated, experienced, and self-driven actuary to join our ** Medicare Duals** team. This role offers a unique opportunity to contribute to… more
- Humana (Palm Bay, FL)
- **Become a part of our caring community and help us put health first** Are you passionate about the Medicare population, looking for an opportunity to work in ... our consumers. **_Face to face interactions in prospective members' home are a requirement for this position._** **Use your...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over… more
- Actalent (Boston, MA)
- …protocol issues, and prioritize urgent amendments. Responsibilities + Train junior staff and review their work for accuracy in Medicare coverage analysis. + Act ... Senior Medicare Coverage Analyst As a Senior Medicare ...you to work from the comfort of your own home . You will be part of the Research Finance department,… more
- Centene Corporation (Cheyenne, WY)
- … materials and sales compliance. Participates in the ongoing oversight, analysis, review , and approval of all beneficiary-facing Medicare materials. In addition, ... , summarization and dissemination of key regulatory updates and changes with the Medicare Marketing Guidelines and relevance on material review . + Provides… more
- OhioHealth (Columbus, OH)
- …Clinics. Knowledge of reimbursement in specialty areas such psych, inpatient rehabilitation units, Home Health and Hospice. Projects as assigned by Director of ... **We are more than a health system. We are a belief system.** We...This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities.… more
- Humana (Milwaukee, WI)
- **Become a part of our caring community and help us put health first** Are you passionate about the Medicare population, looking for an opportunity to work in ... as well as, visiting prospects in their homes. Our ** Medicare Sales Field Agents** sell individual health ...by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or… more
- Humana (Frankfort, KY)
- … first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
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