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The Manager, Medicare Risk Adjustment has organization level responsibilities for the administration of all provisions/requirements of HMSA's Medicare Risk Adjustment program. Provides education and information to the entire HMSA community regarding Medicare Advantage risk adjustment.
$73,154 - $121,252 a yearExpandApply NowActive JobUpdated 0 days ago - UpvoteDownvoteShare Job
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Reporting to the SVP, Sales & Client Management, the Director, Group Medicare Sales, is an integral member of the leadership team—driving BCBSMA’s purposeful re-entry into the Group Medicare Advantage Market.
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The role will have responsibility for Group Medicare Advantage and Medicare Supplementary new sales, retention, growth and account management strategies for all market segments, including meeting/exceeding long, medium and short-term objectives.
$89ExpandApply NowActive JobUpdated 1 days ago - UpvoteDownvoteShare Job
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A Medicare Sales Representative focuses on helping people who are eligible for Medicare find a plan that meets their needs and aids them with the enrollment process. What Does a Medicare Sales Representative Do.
$70,000 - $100,000 a yearFull-timeExpandApply NowActive JobUpdated 1 days ago - UpvoteDownvoteShare Job
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Minimum of 10 years of proven Healthcare sales or consulting experience; Group Medicare experience preferred. Actively works with EMT in support of sales and account relationship strategy to retain and grow our Medicare product suite.
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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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Works collaboratively with the Service Coordinator, Transition Coordinator, and other care team staff to address the member’s identified needsCoordinates with all Medicare payers, Medicare Advantage plans, and Medicare providers as appropriate to coordinate the care and benefits of members who are also eligible for Medicare.
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This role is needed to support the ever-growing list of initiatives across the expanding Medicare Organization (e.g. Customer Retention, DTC, HPOne, Service, Broker, Operations, CSB, etc) This individual will be responsible for delivering initiatives critical to the Cigna's Sales Medicare organization by coordinating across various departmental and matrix partners to deliver critical solutions in support of the Government segment.
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In particular, the AVP will play a critical leadership role in the development of processes relating to Medicare risk adjustment, documentation, and in-home wellness assessments (in partnership with Humana's Medicare Risk Adjustment team, as well as with external strategic partners), given the importance of these areas to the delivery of value-based care.
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Experience in healthcare fraud investigation/detection involving Medicare strongly preferred. The Investigator I is an entry-level professional position that independently performs in-depth evaluation and makes field level judgments related to investigations of potential Medicare fraud, waste and abuse investigations or cases that meet established criteria for referral to the Centers for Medicare & Medicaid for administrative action or to the OIG for criminal action.
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Works closely with theDirector of Value Based Careand/or the Lead RN Care Manager to provide CCM services primarily to a medium acuity panel of Traditional Medicare and Medicare Advantage plan patients who are assigned to his/her care.
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Significant experience with Medicare products and processes, with particular focus on Medicare risk adjustment, documentation, and/or in home wellness assessments. This will include partnering with Medicare leaders on market expansion, as well as with Marketing, Medicare leadership, and other Humana teams on intra-market growth.
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As the Optum Care National Risk Adjustment Healthcare Economics Team, we support all risk adjustment efforts across our enterprise, primarily focused on Medicare Advantage Risk Modeling. As a senior healthcare economics consultant, you will help lead key efforts around risk score forecasting, revenue assessment, predictive suspecting, program evaluations, and strategic guidance related to Medicare Advantage Risk Adjustment.
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The Coder Quality Specialist applies guidance provided for the audit of the following programs; including but not limited to, Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, Commercial IVA (Initial Validation Audit), Medicaid, and Medicare RADV (Risk Adjustment Data Validation.
$23.7 - $34.15 an hourFull-timeExpandApply NowActive JobUpdated 0 days ago - UpvoteDownvoteShare Job
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5 years of leadership specifically in the Medicare payer space, ideally with experience navigating payer-provider organizations. With models ranging from home health to in home wellness assessments to in-home primary and acute care, the Home is a core part of Humana's overall integrated care delivery strategy, and we believe the Home is the next frontier in high touch, value-based care for our members.
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medicare job Title: visiting nurse association Company: Visiting Nurse Association Of Central Jersey
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