- CVS Health (Hartford, CT)
- …Director role are related to Medicare Appeals.* Direct daily work on part C appeals (both provider and member/nonparticipating providers) and Part ... D appeals.* Provide direct support to appeal nurses and dedicated Medicare part D pharmacists; supervision and participation in the Second Look Review (SLR)… more
- The Cigna Group (Nashville, TN)
- …Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C + Ability to differentiate different types of ... requests for service + Working knowledge of Medicare Advantage, Original Medicare and or Medicaid appeal regulations. Understanding of Local Coverage… more
- State of Colorado (Arapahoe County, CO)
- …Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights Minimum Qualifications: Education/Licensure/Certification/Experience: Current, valid ... enrollment in a Masters program for Social Work OR + Addiction Counselor Candidate (AC- C ) Highly Desired Competencies: + CAC III or LAC to support coaching and… more
- Stanford Health Care (Palo Alto, CA)
- If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting ... supportive UM team. You can put your knowledge about Medicare , Medi-Cal, Medicaid, and bedside RN experience to great...is a plus! Our UM team is a great part of SHC's efforts in providing and directing the… more
- Iowa Department of Administrative Services (Independence, IA)
- …of the following: + Compliance with The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and other applicable standards and regulations. + ... classification: 1) All of the following (a, b, and c ): a. Licensure as Registered Nurse in the State...years of education and/or full-time experience (as described in part b), where thirty semester hours of accredited college… more
- Iowa Department of Administrative Services (Des Moines, IA)
- …and is the second largest insurance program in the State of Iowa. Be part of an organization that is continually working to modernize and innovate solutions to ... with sister agencies in addition to the Centers for Medicare and Medicaid Services (CMS) regulators. Tasks involved include:...experience. 3) All of the following (a, b, and c ): a. Two years of full-time professional-level work experience… more
- The Joint Commission (Oakbrook Terrace, IL)
- …Provides guidance on and expert interpretation of Joint Commission standards and Medicare requirements, professional standards of practice, and law and regulation to ... measures, survey outcomes, and data submitted by organizations as part of the intracycle monitoring process in order to...Accreditation Committee of the Board of Commissioners including the appeal process. 4. Works closely with OQPS to provide… more
- The Joint Commission (Oakbrook Terrace, IL)
- …direct reports. People and other resources are managed indirectly as part of cross-functional team delegation required to complete the project. **Responsibilities** ... and certification regulations and policies, and the Centers for Medicare & Medicaid Services (CMS) strategy for transition to...ensure high quality final products. Alters writing style to appeal to various audiences as needed. Willingness to seek… more
- Marshfield Clinic (Neillsville, WI)
- …This brand new state-of-the-art facility opened in May 2021, you will be part of a robust department with a welcoming environment. If desired, this opportunity ... insurance + Relocation support Marshfield Clinic Health System is a non-profit 501( c )(3) organization. This may qualify you for additional state and/or federal… more