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The Program Manager is a key member of the Medicare Advantage Claims, Configuration and Appeals and Grievance Operations team. Assists in planning, developing, implementing, and managing the Medicare Advantage Claims, Appeals and Grievance program requirements, operational initiatives and policies.
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Along with the Assistant Director, Medicare Advantage Operations, the Program Manager is responsible for program management activities impacting the functional areas within the span of control of the Assistant Director including but not limited to initiation, planning, development, and monitoring of program implementations and day to day operations performance monitoring in order to ensure timeliness and compliance.
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The actuary will be a key person on the CVS Accountable Care team that analyzes various sources of patient health and claims data to help the business better understand, forecast and manage the risk position of various value-based products (MSSP, ACO REACH, Medicare Advantage.
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Experience in Medicare Advantage Claims, Appeals & Grievances, program/project management. The incumbent reviews and analyzes key program, regulatory and operational performance indicators for the functional areas reporting to the Assistant Director, Medicare Advantage Operations and makes recommendations to the leadership team on strategies to improve performance.
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Program Manager, Medicare Advantage Operations. Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Medicare Program Manager.
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Requirements: MINIMUM QUALIFICATIONS A Master's Degree in Audiology;Minimum three years of clinical experience with Audiological Evaluations, Hearing Aid Dispensing; assessment across the age range;Current ASHA Certificate of Clinical Competence in Audiology (ASHA CCC-A);Be eligible for NYS licensure in Audiology and Hearing Aid Dispenser license;Be eligible for enrollment with major third-party insurances, Medicare and Advantage Plans.
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Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients businesses forward.
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Contractual arrangements include but are not limited to Medicaid, Commercial, Medicare Advantage, Medicare Accountable Care Organization (ACO) Reach, ACO – Medicaid, Capitation and global shared savings/risk.
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Experience with Microsoft Office Suite (Excel, Word, and PowerPoint) and data visualization tools. Must have at least 3-4 years of managing projects or programs in a healthcare or ACO environment. The Program Manager leads and manages key operational programs, initiatives and strategic projects that span across the functional teams of Claims, Configuration and Appeals and Grievances.
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Instruct patient and family members on proper use of equipment such as wheelchairs, braces, walkers, crutches, canes, and other prosthetic/orthotic devices Policies: Completes all clinical documentation following agency protocol and Medicare/Federal guidelines.
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In cases where Tricare or Medicare/Medicare Advantage is primary or secondary, use scripting to review and deliver appropriate regulatory form (Tricare Rights, Tricare Third Party Liability, and Important Message from Medicare (IMM) form.
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Strong understanding of value-based care which includes -Medicare Advantage Plans and Medicare Shared Savings Accountable Care Organization. The DVBC manages value-based membership growth through various enrollment levers such as; aged-in member conversion, the Medicare Annual Enrollment (AEP) Period, member voluntary alignment, acquisition membership pull through, and new provider/de-novo membership ramp.
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We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Solid understanding of systems development life cycle (Experience with Agile methodologies a plus)Experience with mobile frameworks (Ionic, Xamarin, Flutter, React Native, etc.
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Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
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Sets up and verifies active and contracted insurance coverage in multiple systems and/or educates patients on co-insurances/co-pays, self-pay, L&I, MVA, Medicaid, Medicare/Medicare Advantage, etc.
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medicare advantage jobs Company: Capital Markets Placement
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