- 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
- Elevance Health (Tampa, FL)
- **Manager I Medical Management (Prior Authorizations) - Florida Medicare ** **Office Locations:** This role is based in Florida at either our Tampa or Miami ... granted as required by law._ The **Manager I Medical Management (Prior Authorizations)** is responsible for managing a team...+ Exposure and baseline knowledge of the Centers for Medicare & Medicaid Services ( CMS ) strongly preferred.… 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
- Molina Healthcare (Layton, UT)
- …with the Service Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, ... **Job Summary** This position is responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other… 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
- Humana (Olympia, WA)
- …radiology, and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in ... a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with national guidelines… more
- BAYADA Home Health Care (Orlando, FL)
- …for quality and adherence to policies and procedures. As a member of the Medicare Case Management (MCM) office, individuals in this role are expected to ... to the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each… more
- Actalent (Sunrise, FL)
- …Utilization management + InterQual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical record ... Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management...Milliman Criteria. + Knowledge of Florida Medicaid Program and CMS Guidelines. + Proficient in word processing software, spreadsheet… more
- Corewell Health (Grand Rapids, MI)
- …leaders across the enterprise (eg, Medical Directors, Quality Improvement, Utilization Management , Care Management , Medicare Product Development, Claims, ... receiving LTSS. It also ensures that LTSS operations align with the integration of Medicare and Medicaid benefits under Michigan's HIDE SNP model, meeting CMS … more
- 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