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The Actuarial Senior Specialist helps to coordinate between external consultants and internal staff on annual Medicare Advantage rate filings and assess HHSC's development of the annual Medicaid rates.
$75,000 - $105,000 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Under direction of the Primary Care Physician and supervision of the Nurse Manager of Clinical Services, the RN Transitional Care Manager is responsible to provide services for a panel of Traditional Medicare and Medicare Advantage Plan patients with medical and/or psychosocial problems who have had an emergency room visit and/or skilled care inpatient admission.
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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. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
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Theoria is seeking individuals to join its team to oversee and optimize its value-based care efforts, including the ACO REACH program, Medicare Advantage, and the GUIDE model. Experience in ACO REACH and Medicare Advantage is a must.
$135,000 - $150,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The WellBe care model is a Physician Led, Advanced Practice Provider driven geriatric care (care of older adults) team focused on the care of the frail, poly-chronic, elderly Medicare Advantage patients.
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Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintain PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator.
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Channel Marketing Director, Medicare Advantage - Hybrid The Marketing Director will be responsible for leading the channel marketing team that supports the Cigna Medicare Advantage (MA) business.
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Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan.
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Description : JOB SUMMARYThis job will deliver value to the Health Plan and its beneficiaries enrolled in risk-adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA) through Hierarchical Condition Category (HCC) coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and support of Risk Adjustment Data Validation (RADV) audits.
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En Puerto Rico atendemos a más de 1 millón de aseguradosa través de nuestras líneas de negocios Medicare Advantage, Medicaid,Comercial, Vida y Propiedad & Contingencia. Al unirte a Triple S,serás pieza clave para nuestros esfuerzos de brindar atención médica accesibley de alta calidad, así como también contribuirás a nuestro propósito dehabilitar vidas saludables.
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About NYC Health Hospitals MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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Across the system to achieving optimal success in current and future value-based care contracts (i.e. Medicaid and Medicare Advantage) and opportunities (i.e. risk-based specialty services), including reaching and maintaining a market-leading position in the demonstrated ability to deliver quality clinical, cost and service outcomes for defined challenged populations and communities.
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Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. A physician office building, offering a wide variety of outpatient services - including cardiology, surgical care, orthopedics and podiatry, neurology, OB/GYN, bariatric and weight loss services, and more.
Up to $38.86 an hourExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Foundational understanding with aptitude to become a subject matter expert in Medicare Advantage, ACO REACH, MSSP and other value-based care programs. Medicare Advantage Part C and D bid development expertise.
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Registered Nurse Assessment Coordinator (RNAC) must have Medicare billing knowledge and experience. Conduct and coordinate the completion of the RAI process in accordance with current rules, regulations, and guidelines that govern the resident assessment in accordance with Medicare, Medicaid, OBRA, and other payer programs.
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medicare advantage jobs Company: Carle
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