Utilization Management Manager, Medicare Advantage - Los Angeles

Make a difference in people's lives every day. When you join UCLA Health, you'll be working at an institution that provides leading-edge care to the people of L.A. · Take on a high-impact role within a world-class health organization. · Help drive the continued delivery of except ...

Take on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. · ...

We are seeking a hands-on Medicare Claims Operations professional with deep expertise in Medicare Advantage claims adjudication and managed care environments. · Oversee and manage Medicare Advantage claims adjudication and processing workflows · Configure and maintain claims syst ...

+The Medicare Advantage Risk Adjustment Performance Improvement Specialist will be responsible for serving as a Subject Matter Expert (SME) for risk adjustment with contracted IPAs and collaborating with IPAs on risk adjustment strategies to achieve health plan goals and KPIs. · ...

+Overview:The Prospective Risk Adjustment Operations team is seeking a Strategy Consultant supports the development, execution, and optimization of initiatives that drive prospective risk adjustment performance. · ++FACILITATES STRATEGY DEVELOPMENT BY DEFINING MODERATELY COMPLEX ...

The Prospective Risk Adjustment Operations team is seeking a Strategy Consultant supports the development, · execution, · and optimization of initiatives that drive prospective risk adjustment performance. · This role will collaborate across teams to analyze data, · identify oppo ...

Company Description · Advantage Plus is a national Field Marketing Organization (FMO) headquartered in California, licensed to operate across all 50 states. Specializing in senior insurance marketing, the organization empowers agents to meet clients' Medicare and insurance needs, ...

Company Description · Advantage Plus is a national Field Marketing Organization (FMO) headquartered in California, licensed to operate across all 50 states. Specializing in senior insurance marketing, the organization empowers agents to meet clients' Medicare and insurance needs, ...

Lead strategic direction for Medicare Advantage sales growth across all distribution channels. · Develop and execute multi-channel sales strategy aligned with organizational growth targets and CMS regulatory standards.Manage FMO partnerships and agency distribution channels (5 De ...

We are seeking a Senior Program Manager to lead the oversight and strategic management of key vendors supporting our Medicare Advantage product line. · You will:Oversee multiple complex vendors that support Medicare Advantage supplemental benefits, ensuring delivery against contr ...

We are seeking a Program Manager Claims to lead and coordinate operational initiatives across a delegated MSO / IPA environment. · ...

We're looking for motivated independent Medicare agents who want to plug into a proven system and start scaling their income immediately. · Licensed life/health insurance agents (required) · Self-driven entrepreneurs or experienced agents looking to maximize earning potential · ...

We are seeking a Program Manager – MSO Operations to lead and coordinate operational initiatives across a delegated MSO / IPA environment, · Manage and drive operational programs across MSO / IPA operations, including claims and related workflows · Lead initiatives involving EZ-C ...

The BI Developer will support the launch and reporting needs of a new Medicare Advantage health plan by designing developing and maintaining advanced business intelligence analytics solutions. · The ideal candidate will have strong expertise in CMS claims submission processes HCC ...

Headway helps you launch or expand your private practice by accepting insurance with ease. · You must be a fully-licensed Clinical Social Worker at a Master's level or above with LCSW, LICSW, or LCSCW licensure and valid NPI number and malpractice insurance. · We support provider ...

Support compliance excellence at UCLA Health by joining our team as a Compliance Auditor, MAPD focused on Medicare Advantage Part C and Prescription Drug Part D programs In this vital role you will conduct Risk Adjustment Data Validation RADV audits compliance risk-based audits s ...

UCLA Health Medicare Advantage Plan busca un Medical Director Clinical Operations dedicado para ayudar a moldear el futuro de su plan. · ...

Lead strategic direction for Medicare Advantage sales growth across all distribution channels. · ...

We're seeking a strategic Senior Product Manager to lead the design, development and implementation of our Medicare Advantage products.In this role you'll partner with the Director of Medicare Product Development and Bids to guide the annual bid process drive cross-functional ini ...

We are seeking a Senior Program Manager to lead the oversight and strategic management of key vendors supporting our Medicare Advantage product line. · Oversee multiple complex vendors that support Medicare Advantage supplemental benefits. · Manage supplemental benefit vendors en ...