- US Tech Solutions (Linthicum, MD)
- …program policies and procedures related to Maryland HealthChoice member eligibility redetermination and renewals polices. * Notify members, in accordance ... Maryland Medicaid HealthChoice and Maryland COMAR regulations) of their loss of eligibility . * Ensure copies of notices and documentation are filed in Members'… more
- WellSense (Boston, MA)
- Sr. Provider Relations Consultant - (MA residents)-$5,000 sign on bonus WellSense Health Plan is a nonprofit health insurance company serving members across ... Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide… more
- CareFirst (Baltimore, MD)
- …into the local offices on occasion.** **PURPOSE:** The Sr. Pharmacy Business Consultant provides expertise in tailored, strategic, and critical work to help design, ... pharmacy programs that support initiatives related to Government Programs (Medicaid and Medicare ) with a focus in Quality and Cost of Care. **ESSENTIAL FUNCTIONS:**… more
- Elevance Health (Latham, NY)
- …would provide an equivalent background. **Preferred Qualifications:** + Medicaid and Medicare experience strongly preferred + FACETS or WGS system experience ... equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on… more
- MetroLink (Los Angeles, CA)
- …+ Manage SCRRA's Project Management (PM), Construction Management (CM) consultant contracts, job order contracts, construction contracts, or other necessary ... done in-house or contracted through public bidding. + Manage consultant contracts, contract task orders, schedule, cost, and scope....if he/she is covered under a SCRRA health plan. Eligibility begins the first of the month following hire… more
- The County of Los Angeles (Los Angeles, CA)
- …Facilities Inspection Division and are responsible for either survey services, consultant services, or licensing, enforcement and training services. These positions ... to surveys, and the coordination of work with other Sections. + Consultant Services: Directs a staff of consultants who provide specialized consultative services… more
- SUNY Upstate Medical University (Syracuse, NY)
- … Enrolled with Medicare Identification Number (or PTAN) OR be eligible for Medicare Enrollment within 6 months of hire ( eligibility criteria for NP requires ... their scope of practice. TEACHING AND STAFF DEVELOPMENT 1. Acts as a consultant to nursing staff and when appropriate participates in inservice training for the… more
- NHS Management, LLC (Springdale, AR)
- …other business office related tasks, including but not limited to: + Medicaid, Medicare and/or secondary billing + Assist with evaluation and selection of all ... application process and timely submission to prevent delays in the attainment of eligibility and payment. Process to include: + Meeting with family and or resident… more
- Virginia Mason Franciscan Health (Gig Harbor, WA)
- …FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility , and more! **Responsibilities** **Franciscan Medical Group, a part of ... up of the patient's primary care provider, a psychiatric consultant and, when available, other providers in the primary...hire. + Eligible to be credentialed and enrolled in Medicare and private payers for reimbursement. **Pay Range** $39.19… more
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- …is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of the Actuary (OACT), Medicare and ... care. Serves as CMS's technical and actuarial expert and consultant , exercising significant responsibility for providing technically authoritative advisory services… more
- CVS Health (Harrisburg, PA)
- …logic and various systems to verify accuracy of claim payment, member eligibility data, billing/payment status, and prior to initiation of the appeal process. ... in third party audits, customer meetings, regulatory meetings and consultant meetings when required. + Understands and can respond...as assigned. + Required Qualifications : + 1-2 years Medicare part C Appeals experience. + Experience in reading… more
- TEKsystems (Seattle, WA)
- …able to work a hybrid schedule + Healthcare environment experience. Medicaid, Medicare , and other health care industry experience. + Experienced communicating with ... at the company. + Provides Business Analyst services as an internal consultant to the company business functions to support business requirements elicitation,… more
- HCA Healthcare (Greenwood Village, CO)
- …Learn more about Employee Benefits (https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards) **_Note: Eligibility for benefits may vary by location._** ... require assessment for appropriateness and certification of terminal illness for Medicare /Medicaid hospice services. Plans and evaluates the clinical management of… more
- CVS Health (Springfield, IL)
- …and chronically ill beneficiary across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative ... aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. + Communicates with beneficiary and other… more
- CareFirst (Baltimore, MD)
- …providers who appeal on behalf of members for Maryland Medicaid, Maryland Medicare including (EGWP, DSNP, MAPD). Ensures quality management of the clinical appeal ... - Certified Case Manager Upon Hire Preferred or + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred **Experience:** 5 years' Experience in a managed care… more
- The Joint Commission (Oakbrook Terrace, IL)
- …of assigned services and programs that meet accreditation and certification eligibility criteria, including without limitation the following: + Review and evaluate ... performance reviews, evidence of standards compliance reports, complaints, and Medicare out-of-compliance reports. 4. Collaborate in a productive manner with… more
- Indian Health Service (Gallup, NM)
- …meeting Indian Health Service Chapter 39 and The Joint Commission(TJC)/Centers for Medicare & Medicaid Services (CMS) standards. This Job Announcement is Open Until ... Stewardship Program, Pathology and Laboratory Service and Pharmacy Service Serves as consultant in planning, monitoring and evaluating drug programs or regimens by… more
- CVS Health (Freeport, IL)
- …models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social ... delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements,… more
- CVS Health (Springfield, IL)
- …delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements ... chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative… more
- CVS Health (Houston, TX)
- …delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements, ... chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative… more