- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …in health care, health plans, Covered California, Medicaid Managed Care Plans (MCPs), Medicare Advantage , Medicare Part D, Special Needs Plans (SNPs), ... performs key centralized complex and difficult regulatory activities for the Compliance Department. Team Members in this position ensure plan operations, processes,… more
- Presbyterian Healthcare Services (Albuquerque, NM)
- …nurses.Our health plan serves more than 580,000 members statewide and offers Medicare Advantage , Medicaid (Centennial Care) and Commercial health plans.Inclusion ... defect lifecycle. Ensure the quality and reliability of RPA bots and their compliance with defined business rules and requirements.Validate the bot in UAT phase and… more
- Presbyterian Healthcare Services (Albuquerque, NM)
- …nurses.Our health plan serves more than 580,000 members statewide and offers Medicare Advantage , Medicaid (Centennial Care) and Commercial health plans.Inclusion ... effective in support of business initiatives, accreditation, and regulatory compliance .Discern patterns and correlate diverse set of information, conceptualize and… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …This position manages administrative elements of the Companies' (LHSIC, HMOLA, and VHP) Medicare Advantage Compliance Program , including development and ... on Compliance objectives, projects, timelines, and deliverables for the Medicare Advantage Compliance Program . Create and maintain compliance… more
- CTG (CA)
- …oversee our customer service operations across multiple call centers to manage our Medicare Advantage Plan Call Center. The ideal candidate will possess strong ... and a thorough understanding of customer service best practices in the healthcare Medicare Advantage industry. As the Customer Service Manager, you will be… more
- Highmark Health (Charleston, WV)
- …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
- UCLA Health (Los Angeles, CA)
- …relationship-building skills with clinical and non-clinical personnel + Knowledge of the Medicare Advantage STARS program and NCQA technical specifications ... at UCLA Health. As a key leader within our Medicare Advantage team, you will develop and...accuracy, efficiency, and adherence to all regulatory and CMS compliance requirements. You will manage the coding consultants who… more
- The Cigna Group (Atlanta, GA)
- **Marketing Advisor, DTC Advertising ( Medicare Advantage ) - Hybrid** Responsible for day-to-day management of direct-to-consumer advertising. Play a pivotal role ... with other channels, meet brand standards and can positively impact Cigna's Medicare Advantage growth goals. **Responsibilities** + Partner to provide the… more
- UCLA Health (Los Angeles, CA)
- …of Pharmacy Benefits Management! Reporting directly to the Chief Medical Officer of Medicare Advantage , you'll spearhead the development and oversight of our ... both internal stakeholders and external partners to ensure adherence to compliance requirements while optimizing costs. Salary Range: $146,900 - $371,300/annually… more
- The Cigna Group (Birmingham, AL)
- …group contracting and negotiations** + **Experience with Healthcare - Commercial and Medicare Advantage ** + Experience in developing and managing key provider ... to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance , Sales and Marketing and Service. + Manages strategic positioning… more
- CVS Health (Phoenix, AZ)
- …support for the elements and compliance department responsibilities required under the Medicare Compliance Program , which include but are not limited to ... Compliance position that supports the compliance program activities and deliverables of a Medicare ...and program policy related obligations as a Medicare Advantage organization + In partnership with… more
- MarketSource (Alpharetta, GA)
- …and lead the insurance compliance management strategy for the organization's Medicare Advantage sales program including carrier compliance , ... culture of insurance compliance awareness * Ensure compliance with regulatory obligations including Centers for Medicare...and may be subject to specific elections, plan, or program terms. This role may be eligible for the… 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 ... responsible for educating and enrolling potential beneficiaries by explaining program benefits in a manner that is compliant with...issued by Centers Plans for Healthy Living MAP and Advantage Care Medicare HMO Plan. Enrollment application… more
- The Cigna Group (Bloomfield, CT)
- …strategy and execution for the direct sales of Cigna Seniors products, including Medicare Supplemental, Supplemental Health, Medicare Advantage , and PDP. The ... lines. + Define, track, and manage state and federal compliance requirements across all aspects of telesales model. +...optimism and confidence in the future. + Experience in Medicare Supplement and/or Medicare Advantage … more
- LA Care Health Plan (Los Angeles, CA)
- …of business. Experience in improving Stars and Quality Measures. Experience in Medicare Advantage , with experience serving duals population. Direct experience in ... monitoring programs and enhancements to promote efficiency, quality, and compliance . Partner with functional areas to involve day-to-day issues... Medicare and Duals program administration including stars,… more
- Somatus (Mclean, VA)
- …Programs to optimize the programs' clinical benefit, financial accuracy and ensure program compliance with governing bodies' regulations, including the Center ... for risk score accuracy. + Responsible for the program to meet full compliance with state,...enrollment etc. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven… more
- Medical Mutual of Ohio (OH)
- …offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans ... acute physical rehabilitation, and long-term acute care hospitals, to ensure compliance with criteria guidelines, member eligibility, benefits and contracts. +… more
- The Cigna Group (Baltimore, MD)
- …Components** All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: + ... with STARS, HEDIS, Risk Adjustment and medical expense reduction, specific to Medicare Advantage required + Required - Microsoft Outlook, Excel, PowerPoint,… more
- Universal Health Services (Reno, NV)
- …organization to execute key initiatives for the effectiveness of the Compliance Program for health plan products, including Medicare Parts C and D, large- ... follow-up. The Compliance Analyst will support the Compliance Program to ensure compliance ... compliance ; experience with managed care organizations and Medicare Advantage preferred. + Experience with State… more
- Dartmouth Health (Lebanon, NH)
- …compliance regulations related to the First-Tier, Downstream and Related Entity (“FDR”) Medicare Compliance Program Guidance in collaboration with DH ... . The role will also administer oversight to comply with Medicare Advantage directed First-Tier Downstream Related Entity (FDR) compliance program .… more
