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Midas Consulting
Jersey City, NJ, United States
Job Title - BA/PM -Medicare /Medicaid Location - 3 Penn Plaza East, Newark-NJ ONSITE DAY ONE - needs to be in office 1-2 Days/ week Duration -12 month Experience/Skillset - Medicare or Medicaid • 9+ years of experience as a Senior Business System Analyst is required. • At least 5-6 years of experience in the health insurance industry is require
Job Source: Midas ConsultingNYC Health Hospitals
New York, NY, United States
MetroPlus Health 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. As a w
Job Source: NYC Health HospitalsHorizon Blue Cross Blue Shield of New Jersey
Newark, NJ, United States
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: This position is responsible for ensuring that Medicare Advantage membership enrollment is in sync by reconciling CMS enrollment records and Horizon enrollment records via review of Daily Transaction Reply Reports (DTRR) and the Monthly
Job Source: Horizon Blue Cross Blue Shield of New JerseyAccenture
Florham Park, NJ, United States
We are... We are a global collective of innovators applying the New every day to improve the way the world works and lives. New doesn't mean being ahead of the curve; new is pushing forward the curve, riding the edge where the impossible meets the transformational and making it reality where it matters. Help us show the world what's possible as yo
Job Source: AccentureVillageCare
New York, NY, United States
Medicare Product Manager VillageCare has an exciting opportunity for a Full-Time Medicare Product Manager! This fully remote position allows you to work from the comfort of your own home while making a significant impact in the health care industry. You will have the chance to lead innovative projects and collaborate with a dynamic team to enhance
Job Source: VillageCareAccenture
Florham Park, NJ, United States
We are ? We are a global collective of innovators applying the New every day to improve the way the world works and lives. New doesnt mean being ahead of the curve; new is pushing forward the curve, riding the edge where the impossible meets the transformational and making it reality where it matters. Help us show the world whats possible as you pa
Job Source: AccentureCentene Corporation
New York
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. **Education/Experience:** Bachelor's degree in Healthcare, Ma
Job Source: Centene CorporationCenters Plan for Healthy Living
Staten Island
Medicare MAP Advisor 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #266 Monday, July 1, 2024 Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living. JOB SUMMARY
Job Source: Centers Plan for Healthy LivingLittle Ferry, NJ, United States
Guided Medicare Solutions is an insurance agency founded in 2004 focused on offering affordable healthcare solutions. By partnering with healthcare providers and community organizations our team has established itself as one of the leading FMO's in the Medicare industry.
The National Operations Director will be responsible for overseeing the day-to-day operations of the Medicare and ACA business in the United States. Reporting to the Executive Director, Medicare/ACA, this position will develop and implement operational strategies. Using proprietary and third-party technology. Manage compliance and quality assurance, contracting, hierarchies, optimize financial performance, and build and maintain strong relationships with Medicare providers and external partners.
Key Responsibilities
Develop and implement operational strategies that comply with regulatory standards and support business objectives
Lead the development and implementation of operational policies and procedures to ensure efficient and effective Medicare and ACA plan operations
Monitor and analyze plan performance and financial results to optimize healthcare outcomes and profitability
Collaborate with cross-functional teams to identify areas for improvement and implement solutions
Work with the compliance and quality departments to ensure plans adhere to all regulatory requirements and quality standards
Build and maintain relationships with Medicare providers, vendors, and external partners to ensure optimal results
Facilitate the development and execution of network agreements, contracting, and negotiations with healthcare providers
Provide leadership and direction to operational teams, including hiring, training, and performance management
Ensure timely and accurate reporting of healthcare data to regulatory agencies and other stakeholders
Qualifications
Bachelor's degree in healthcare administration or related field
Minimum 10 years of experience in Medicare and/or ACA operations or similar role
Knowledge of Medicare/ACA regulations and compliance requirements
Experience managing provider networks and negotiating contracts
Strong leadership and interpersonal skills
Ability to drive results and make data-driven decisions
Excellent written and verbal communication skills
Proven project management skills
Demonstrated ability to work collaboratively with cross-functional teams
Strong analytical and problem-solving skills
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Email Alert for Director of Operations, Medicare - Guided Medicare jobs in Little Ferry, NJ, United States
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