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Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. The Director, Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation of the organization’s Risk Adjustment Programs to optimize the programs’ clinical benefit, financial accuracy and ensure program compliance with governing bodies’ regulations, including the Center for Medicare and Medicaid Services.
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Issues of focus will span the health policy landscape, including but are not limited to the Medicare program (Medicare Part B, Medicare Part D, Medicare Advantage), Medicaid, the 340B program, the Affordable Care Act's health insurance exchanges, and other state policy issues (e.g., drug pricing legislation such as drug affordability review boards, pharmacy benefit managers (PBMs) regulation, etc.
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The Director, Health Policy Programs manages timely policy research, analysis, and publications to drive and support the priorities of AARPs Public Policy Institute, particularly on Medicare and related Medicaid issues.
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This position requires the successful completion of pre-employment checks to include: FBI Criminal Record Check; VA State Child Abuse/Neglect Registry; Drug Testing; Medicare/Medicaid Fraud Database; Driver's License from state of residence and education/certifications.
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Under the direction of the Director, Federal Government Relations, the Government Relations Manager represents the American Heart Association before Congress, the Executive Branch, and coalition partners on a portfolio of legislative issues including preserving and expanding healthcare access through the Medicare, Medicaid, and Affordable Care Act programs; women and childrens health; cardiac rehabilitation; and peripheral artery disease.
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As a Remote MTM Pharmacist, you will play a crucial role in providing direct patient outreach and medication management services to Medicare patients. We are seeking a highly skilled Remote MTM Pharmacist to join our team for a contract position, starting now and extending through October 2024 with potential for further extension.
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Exclusive Insurance Payor Access: Only SonderMind provides complimentary credentialing for both traditional Medicare and Medicare Advantage plans, including Humana and United Healthcare.
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EGT’s innovative advantage is the horizontal R&D services of EGT Labs focused on high-value, repeatable solutions in Artificial Intelligence (AI), Robotic Process Automation (RPA), DevSecOps, and cloud transformation to solve customer challenges and they surface and advance program mission.
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Notes This position requires the successful completion of pre-employment checks to include: FBI Criminal Record Check; VA State Child Abuse/Neglect Registry; Drug Testing; Medicare/Medicaid Fraud Database; Driver's License from state of residence and education/certifications.
$20.04 - $26.84 an hourPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Virginia Hospital Center was recently designated a Newsweek 2020 Best Maternity Care Hospital, received a 5-star rating from the Centers for Medicare and Medicaid Services (CMS) and once again named a Leapfrog Top Hospital in 2019.
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Position SummaryThe Director of Public Policy supports and enhances effective Federal advocacy related to Medicare Part D and drug pricing issues, as well as other Federal and State PBM policy issues including transparency requirements and benefit mandates through strategic issue assessment, policy development and analysis, timely production of advocacy materials, thought leader development, and coalition building.
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Engage in brainstorming sessions and propose innovative solutions and approaches that take full advantage of AWS cloud-native services and technologies to meet the evolving needs of the US Census Bureau.
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Complete understanding of all levels of MCO/Medicare/Medicaid reimbursement issues and impact on business performance; identify potential obstacles and lease with Market access to effectively resolve.
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At least 12 years of experience in positions of increasing responsibility in evaluation research, policy analysis, quantitative analytics for fraud, waste and abuse detection, data mining, data modeling, or related field (or equivalent education) including at least 5 years of policy project managementExpert knowledge of Traditional Medicare, Medicare Parts C & D, and Medicaid policy including ongoing value-based care initiatives.
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Experience with AWS services such as EC2, S3, RDS, VPCs, CloudFront, IAM, and Route 53 would be an advantage. Familiarity with application frameworks such as Spring Boot, Django, or Flask. Certification in IT disaster recovery (e.g., CBCP, ITIL.
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medicare advantage jobs Company: Capital Markets Placement in Washington, DC
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