- Humana (Columbus, OH)
- …in the country. **Location:** remote 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...prior management consulting experience to support delivering some of Medicare and Medicaid 's highest priority projects and… more
- Humana (Columbus, OH)
- …in the country. Location: remote 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...meaningful management consulting experience to support delivering some of Medicare and Medicaid 's highest priority projects and… more
- PruittHealth (Athens, GA)
- …local meeting places as needed; * Substantial sales experience; * Knowledge of Medicare / Medicaid and/or nursing community dynamics. * Demonstrate compliance ... they provide ongoing marketing support to our in-network skilled nursing facility staff, conduct facility and community marketing events,...6. Ability to learn and carry out Centers for Medicare & Medicaid Services rules and regulations.… more
- 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
- PruittHealth (Moultrie, GA)
- …local meeting places as needed. * Substantial sales experience. * Knowledge of Medicare / Medicaid and/or nursing community dynamics. * Demonstrate compliance ... they provide ongoing marketing support to our in-network skilled nursing facility staff, conduct facility and community marketing events,...6. Ability to learn and carry out Centers for Medicare & Medicaid Services rules and regulations.… more
- The Cigna Group (Bloomfield, CT)
- …consumer. Ideal candidate would have previous case management experience with the Medicare / Medicaid population specifically focusing on Special Needs Plan. Model ... **The job profile for this position is Nurse Case Management Senior Analyst, which is a...3 Senior Contributor Career Track Role.** For this position, Nurse Case Manager Senior Analyst, through the case management… more
- Kelsey-Seybold Clinic (Houston, TX)
- …associated professional claims. Essential job functions include: Apply knowledge of Centers for Medicare & Medicaid Services (CMS) rules specific to DRG pricing ... high dollar claims and present summary to management. **Job Title: Medicare Claims Analyst** **Location: Remote** **Department:** **Claims** **Job Type: Full Time**… more
- Humana (Columbia, SC)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... resident AND have at least ONE of the following designations: + Registered Nurse (RN) + Actively certified by the American Academy of Professional Coders (AAPC)… more
- Elevance Health (Smithfield, RI)
- …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
- 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
- The Cigna Group (Bloomfield, CT)
- …years related experience and/or training in Case Management + 1-2 years of oncology nursing experience + Medicare and/or Medicaid experience with geriatric ... of Cigna Healthcare Policies and Procedures, CMS requirements, State Medicaid requirements, NCQA standards and recommendations impacting care coordination, and… more
- Molina Healthcare (Detroit, MI)
- …unrestricted RN license in the state of MI. This position will support our MMP ( Medicaid Medicare Population) that is part of the Personal Care team. This ... For this position we are seeking a (RN) Registered Nurse who must live and have a current active...QUALIFICATIONS** **Required Education** Graduate from an Accredited School of Nursing **Required Experience** + At least 1 year of… more
- Fairview Health Services (Edina, 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
- Medical Mutual of Ohio (OH)
- …Assurance (NCQA) accreditation requirements, Quality Programs, and regulations such as Medicare Advantage, Medicaid , and Marketplace Exchange, and Office of ... NCQA applications, submissions, and onsite surveys for the Commercial, Exchange, Medicare / Medicaid Products.** **Collaborates with Legal on assuring the accurate… more
- UT Health (Houston, TX)
- …applications and their maintenance in accordance with state and federal Centers for Medicare and Medicaid Services (CMS) regulations. This role is also ... and Railroad Medicare applications for all billing providers. + Completes Medicare / Medicaid revalidations for all billing providers. + Trains junior provider… more
- University of Rochester (Rochester, NY)
- …Consistently monitors resident's insurance coverage to ensure eligibility. + Knowledge of Medicare 's nursing home guidelines and limited coverage. + Attends the ... assesses all aspects of patient financial account management for nursing home stays. The Financial Counselor is accountable for...to type 45 words per minute. Strong knowledge of Medicare , Medicaid and HMO processes. High comfort… more
- Fairview Health Services (Edina, 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
- Henry Ford Health System (Troy, MI)
- …pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, Medicare Advantage, Medicare - Medicaid Program (MMP), and Medicaid ... and grievances following established guidelines from: The Center for Medicaid and Medicare Services (CMS), MAXIMUS Federal...two (2) years of experience as a Licensed Practical Nurse (LPN) in the State of Michigan preferred. +… more
- Humana (New York, NY)
- …across Humana's businesses. The team has a strong dotted-line partnership with the Medicare and Medicaid organization, Humana's largest, which comprises over 80% ... reinvention. It has transformed itself from the largest US nursing home company in the '60s, to the largest...an experienced team member to support delivering some of Medicare and Medicaid 's highest priority projects and… more
- Humana (Tampa, FL)
- …contributes to the development, implementation, and management of the company's Medicare / Medicaid Five-Star Quality Rating System. The Senior Stars Improvement, ... skills to make an impact** **Required Qualifications** + Registered Nurse + 5 or more years of Medicare...over 23 years. CarePlus strives to help people with Medicare , or both Medicare and Medicaid… more