- Highmark Health (Buffalo, NY)
- …are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with ... STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the needs… more
- CVS Health (CT)
- …it all with heart, each and every day. **Senior Manager Product Strategy, Medicare Advantage ** **Job purpose and summary:** The Senior Manager Product Strategy, ... Medicare Advantage is responsible for the support and development in the execution of strategic initiatives that drive growth, profitability and competitive… more
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and ... CPT and CPT (II), and HCPCS coding systems + Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical specifications + Knowledge of HIPAA… more
- CVS Health (Blue Bell, PA)
- …medical cost assumptions used in annual pricing and bid development for Individual Medicare Advantage . This role ensures all assumption models are completed ... SQL is desired - Strong communication skills **Preferred Qualifications** - Experience with Medicare Advantage products - Fellow of the Society of Actuaries… more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Performance Improvement Specialist, you will be responsible for: + Serving as a Subject Matter Expert (SME) ... or more years of health plan experience, highly desired + Knowledge of Medicare Advantage , STARS/HEDIS program, and NCQA technical specifications + Knowledge and… more
- UCLA Health (Los Angeles, CA)
- …Take on a key role within a world-class, award-winning health system. Contribute to the delivery of award-winning patient care. Take your career in an exciting new ... direction. You can do all this and more at UCLA Health. You will be responsible for accurate and timely data entry, and the review and adjudication of professional, ancillary, and institutional claims for services rendered in our inpatient, ambulatory and… more
- Medical Mutual of Ohio (OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. This position ... of Medical Mutual's Medicare Compliance Program, which supports both Medicare Advantage and Medicare Supplement products. Reporting directly to the Chief… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …throughout the five (5) boroughs. Territory Management + Maintain CPHL MAP and Medicare Advantage Plan visibility in the community by monitoring multiple ... equipment issued by Centers Plans for Healthy Living MAP and Advantage Care Medicare HMO Plan. Enrollment application process + Ensures prospective members are… more
- UCLA Health (Los Angeles, CA)
- Description Lead strategic direction for Medicare Advantage sales growth across all distribution channels. You'll manage a comprehensive sales organization ... with progressively responsible managerial roles, with a minimum 5 years in Medicare or Medicare Advantage environment + Minimum 10 years of management-level… more
- CVS Health (Downers Grove, IL)
- …with internal senior level corporate compliance and business teams that operate Medicare Advantage in a highly complex regulatory environment and highly ... and teamwork **Required Qualifications:** + 7+ years' experience in Medicare or Medicare Advantage government healthcare program compliance or regulatory… more
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