• Medical Director- Medicare (CA)

    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
    Molina Healthcare (11/21/24)
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  • Investigative Auditor - Medicaid Fraud

    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
    State of Georgia (10/30/24)
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  • Medicare Biller / Accounts Receivable

    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
    CommuniCare Health Services Corporate (11/13/24)
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  • FV Partners Nurse Care Coord

    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 (11/25/24)
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  • FV Partners Nurse Care Coordinator

    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 (11/15/24)
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  • FV Partners SW Care Coordinator

    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 (11/25/24)
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  • FV Partners SW Care Coordinator

    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 (11/15/24)
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  • Clinical Review RN

    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
    Centers Plan for Healthy Living (11/06/24)
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  • Customer Solution Center Appeals and Grievances…

    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
    LA Care Health Plan (11/20/24)
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  • Care Coordinator, RN

    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 (10/29/24)
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  • Insurance Strategy Consultant

    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
    Humana (11/05/24)
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  • Care Manager RN

    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
    Central Maine Medical Center (09/29/24)
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  • Accounts Receivable Billing Specialist

    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
    Wesley Enhanced Living (09/26/24)
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  • Psychiatrist 3, Buffalo Psychiatric Center

    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
    New York State Civil Service (10/19/24)
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  • Nurse Investigator

    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
    State of Georgia (09/20/24)
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  • SCO Nurse Case Manager-Lowell/Lawrence Area

    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
    Fallon Health (11/09/24)
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  • Medical Specialist 2

    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
    New York State Civil Service (11/06/24)
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  • Clinical Nurse Long Term Care

    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
    Corewell Health (09/24/24)
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  • Audit & Reimbursement Senior- Appeals

    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
    Elevance Health (11/16/24)
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  • Registered Nurse Supervisor 1 Psychiatric,…

    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
    New York State Civil Service (11/23/24)
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