• Medicare Advantage Quality

    Highmark Health (Buffalo, NY)
    …the Organization are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for ... STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess… more
    Highmark Health (11/06/25)
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  • Quality & Risk Adjustment Provider…

    Blue Cross and Blue Shield of Minnesota (Eagan, MN)
    Quality and Manager (CHQM) * Registered Nurse * Solid knowledge of Medicare Advantage Business Compensation and Benefits: Pay Range: $88,600.00 - $117,400.00 ... Blue Cross and Blue Shield of Minnesota Position Title: Quality & Risk Adjustment Provider Consultant Location:...Position Title: Quality & Risk Adjustment Provider Consultant Location: Hybrid | Eagan, Minnesota Career Area: Customer… more
    Blue Cross and Blue Shield of Minnesota (12/30/25)
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  • Risk Adjustment QA Consultant

    Blue Cross and Blue Shield of Minnesota (Eagan, MN)
    …experience will be considered. * Experience in medical coding with a focus on Medicare Advantage and ACA risk adjustment. * Certified Risk Adjustment Coder (CRC) ... The Impact You Will Have As a Risk Adjustment Quality Assurance (QA) Consultant at BCBSMN, you'll...certification * In-depth knowledge of ACA & Medicare Advantage risk adjustment methodology, coding guidelines… more
    Blue Cross and Blue Shield of Minnesota (12/10/25)
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  • Provider Management Consultant

    Health Care Service Corporation (Chicago, IL)
    …CMS regulatory requirements, including Medicare Marketing Guidelines + Experience with Medicare products (including Medicare Advantage , Medicare ... and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The… more
    Health Care Service Corporation (12/06/25)
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  • Litigated Claims Consultant | Public Entity…

    Sedgwick (San Juan, PR)
    …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Litigated Claims Consultant | Public Entity | Remote **Are you looking for an impactful job ... global company known for its excellence and customer service. + Take advantage of a variety of professional development opportunities that help you perform… more
    Sedgwick (12/16/25)
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  • Principal Risk Adjustment Healthcare Analyst

    Blue Cross and Blue Shield of Minnesota (Eagan, MN)
    …data analysis. This roleleveragesdeepexpertiseinRiskAdjustment and healthcare data-primarily Medicare Advantage , Medicaid, and ACA Commercial-identifyingtrends ... have experience inRiskAdjustment methodologies, clinical coding, and healthcare programs ( Medicare Advantage , Medicaid, ACA Commercial), as well asproficiencyin… more
    Blue Cross and Blue Shield of Minnesota (12/22/25)
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  • Primary Care Physician Lead

    CenterWell (Anderson, SC)
    …of three to five years directly applicable experience preferred + Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice coding and documentation in… more
    CenterWell (12/25/25)
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  • Primary Care Physician Lead

    CenterWell (Savannah, GA)
    …of three to five years directly applicable experience preferred + Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice coding and documentation in value… more
    CenterWell (12/25/25)
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  • Market CMO, Centerwell Senior Primary Care…

    CenterWell (Phoenix, AZ)
    …of three to five years directly applicable experience preferred + Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice coding and documentation in value… more
    CenterWell (10/24/25)
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  • Managed Care Contracts Director

    UNC Health Care (Morrisville, NC)
    …management of: commercial fee-for-service and value-based managed care payer contracts; Medicare Advantage and Managed Medicaid managed care fee-for-service and ... revenue that could cover any part of the managed care spectrum (commercial, Medicare Advantage , Medicaid Managed Care, specialty and carve-out services, direct… more
    UNC Health Care (01/02/26)
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