- Molina Healthcare (Long Beach, CA)
- …the medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid , NCQA and other regulatory requirements. + Reviews quality ... Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare . **PREFERRED EDUCATION:** Master's in Business Administration,… more
- State of Georgia (Fulton County, GA)
- …+ Obtains and maintains comprehensive knowledge of operations and reimbursement policies of Medicare and Medicaid programs. + Works with investigative team to ... Investigative Auditor - Medicaid Fraud Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/52416/other-jobs-matching/location-only) Hot… more
- CommuniCare Health Services Corporate (Indianapolis, IN)
- …and Medicare Secondary Payer claims for accuracy and timely submission per Medicare , Commercial, and Medicaid billing guidelines + Submission of Medicare ... on unpaid claims and document account within standard billing cycle time frame ( Medicare : 16 days after submission , Commercial/ Medicaid Coinsurance: 14-21 days… more
- Fairview Health Services (Edina, MN)
- …Services (DHS), the Minnesota Department of Health (MDH) and the Centers for Medicare and Medicaid Services (CMS). **Job Expectations:** Assessment + Conducts ... according to MCO, Minnesota Department of Human Services (DHS) and Centers for Medicare & Medicaid Services (CMS) guidelines + Performs additional clinical… more
- Fairview Health Services (Maplewood, MN)
- …Services (DHS), the Minnesota Department of Health (MDH) and the Centers for Medicare and Medicaid Services (CMS). This position will serve Fairview Partners ... according to MCO, Minnesota Department of Human Services (DHS) and Centers for Medicare & Medicaid Services (CMS) guidelines + Performs additional clinical… more
- Fairview Health Services (Edina, MN)
- …Services (DHS), the Minnesota Department of Health (MDH) and the Centers for Medicare and Medicaid Services (CMS). **Job Expectations:** Assessment + Conducts ... according to MCO, Minnesota Department of Human Services (DHS) and Centers for Medicare & Medicaid Services (CMS) guidelines + Performs additional clinical… more
- Fairview Health Services (Maplewood, MN)
- …Services (DHS), the Minnesota Department of Health (MDH) and the Centers for Medicare and Medicaid Services (CMS). This position will serve Fairview Partners ... according to MCO, Minnesota Department of Human Services (DHS) and Centers for Medicare & Medicaid Services (CMS) guidelines + Performs additional clinical… more
- Centers Plan for Healthy Living (Margate, FL)
- …responsible for the review of the admission, resumption, recert and discharge assessments for Medicare , Medicaid , Medicare / Medicaid HMO cases to ensure ... team Qualifications + Graduate from an accredited School of Nursing . + 3-5 years of home care experience +...home care experience + Strong knowledge of OASIS and Medicare / Medicaid guidelines + OASIS and or Coding… more
- LA Care Health Plan (Los Angeles, CA)
- …least 5 years of experience in Clinical Nursing and 2 years in Medicare / Medicaid in a managed care/ health plan environment. Skills Required: Excellent ... Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department:...in a manner consistent with LA Care, Centers of Medicare and Medicaid Services (CMS) and regulatory… more
- Humana (Richmond, IN)
- …home diversion or long-term care case management experience + Prior experience with Medicare & Medicaid recipients + Experience working with a geriatric ... + Perform job responsibility in Indiana + Licensed Registered Nurse (RN) in the state of Indiana without restrictions...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- Humana (Columbus, OH)
- …benefits organizations in the country. The Healthcare Strategy team supports Humana's Medicare and Medicaid business unit. This business unit, Humana's largest, ... reinvention. It has transformed itself from the largest US nursing home company in the 60's, to the largest...leveraging core consulting skills to support delivering some of Medicare and Medicaid 's highest priority projects and… more
- Central Maine Medical Center (Lewiston, ME)
- …patients for discharge planning and utilization review. This includes those who may have Medicare , Medicaid , HMO, or private insurance to cover their stay at ... various units. Discharge planning is coordinated with physicians, nursing , patients, and significant others who have an ongoing...discharge planning in addition to knowledge of criteria for Medicare , Medicaid coverage and that of HMO… more
- Wesley Enhanced Living (Warminster, PA)
- …in Long Term Care (LTC) billing with knowledge of Point Click Care, medicare , medicaid , and third party billing for skilled nursing homes. + Long Term Care ... collection of account receivables for a group of skilled nursing facility and a central billing environment, within the...primary, secondary and private co-pays. + Coinsurance billing for Medicare A & B + Private collections Medicaid… more
- New York State Civil Service (Buffalo, NY)
- …listed as an excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal or ... participate to the degree necessary to allow for your services to be billed through Medicare and Medicaid . If you are appointed and lose the ability to bill… more
- State of Georgia (Fulton County, GA)
- …for Job Alerts The Office of the Attorney General Georgia Department of Law Nurse Investigator- Medicaid Fraud Division *To move forward in the recruiting ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/51086/other-jobs-matching/location-only)... Program; state and federal laws and policies governing Medicare and Medicaid . + Applies appropriate regulations,… more
- Fallon Health (Lawrence, MA)
- …live in our service area, and who have MassHealth Standard, and may have Medicare . It combines MassHealth ( Medicaid ) and Medicare benefits, including ... we strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid , and PACE- in the region. **Learn more at… more
- New York State Civil Service (Thiells, NY)
- …listed as an excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal or ... to allow for your services to be billed through Medicare and Medicaid . If you are appointed...Staff.* Additional duties will include working with medical and nursing staff on improving care, medical representation on teams,participation… more
- Corewell Health (Dearborn, MI)
- Post Acute Care Units A Wing is a 58 bed Medicare / Medicaid unit that has residents with multiple clinical issues including CHF, dehydration, cellulites, ... and personal satisfaction. B Wing is a 40 bed Medicare / Medicaid /Dementia unit. We provide care to residents...Associate's Degree or equivalent ADN + Experience in Skilled Nursing /Long Term Care. Preferred + LIC-Registered Nurse … more
- Elevance Health (Columbus, OH)
- …government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs. The **Audit ... Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of...of Medicare part A reimbursement such as Medicare DSH, Bad Debts, Medical Education, Nursing … more
- New York State Civil Service (Brooklyn, NY)
- …listed as an excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal or ... HELP Yes Agency Mental Health, Office of Title Registered Nurse Supervisor 1 Psychiatric, (NY HELPS), Kingsboro Psychiatric Center,...to allow for your services to be billed through Medicare and Medicaid . If you are appointed… more