- Elevance Health (Overland Park, KS)
- ** Kansas Medicaid Compliance Consultant Senior** **Location: Must be located in/a resident of Kansas ** This position will take part in Elevance Health's ... plan leadership, and ensures key interactions with the Kansas are appropriately addressed. **How You Will Make an...interpretation and enforcement of those requirements and owns the Kansas Medicaid Compliance Committee. +… more
- The Cigna Group (Bloomfield, CT)
- …with overall Compliance Department work plans. + Maintain the Express Scripts Medicaid and Commercial Compliance Plan Summaries. + Coordinate quarterly ... and Commercial will serve as the Express Scripts Medicaid Compliance Officer and have direct oversight...effectively engage with various audiences including internal partners, health plan clients, as well as federal and state regulators.… more
- CenterWell (Kansas City, MO)
- …primary care 'on-call' program of CenterWell as needed. * Assures personal compliance with licensing, certification, and accrediting bodies. * Spend 100% of your ... and unrestricted DEA license + Medicare Provider Number + Medicaid Provider Number + Minimum of two to five...per yearThis job is eligible for a bonus incentive plan . This incentive opportunity is based upon company and/or… more
- The Cigna Group (Bluffton, SC)
- …Adjustment-is required.** 5+ years of experience working with Medicare Advantage, Medicare- Medicaid . Plan (Dual-Eligible) and/or Medicaid . **Certified Coding ... Responsible for Part C audit activities for the Cigna Compliance Department, with particular emphasis on Coding, Risk Adjustment and Coding Decisions. Collaborates… more
- Organon & Co. (Bloomington, IN)
- …collaborative Women's Health point of contact for Organon for the following: + State Medicaid & Managed Medicaid Plans + State FQHCs Administration and Policy ... + Develops relations with key public health officials such as state, Medicaid , city and county health department directors, state family planning program directors,… more
- Prime Healthcare (Kansas City, KS)
- …making a difference. Providence Medical Center, located near I-435 and Parallel Pkwy in Kansas City, Kansas , offers an extensive array of diagnostic and medical ... can sit in any Prime Healthcare Hospital Regional Manager, Managed Care - Health Plan Operations is responsible for the management and data integrity of the managed… more
- Elevance Health (Topeka, KS)
- …with provider education and training is very strongly preferred. + Knowledge in available Kansas Medicaid programs and resources. + Medicaid or LTSS claims ... and overseeing a comprehensive initial and ongoing provider training and communication plan , ensuring the provider network has the resources, tools, and supports… more
- The Cigna Group (Bloomfield, CT)
- …will coordinate and perform all appeal related duties in a Medicare Advantage Plan . These appeals will include requests for decisions regarding denials of medical ... via oral and written communication; researching and applying pertinent Medicare and Medicaid regulations to determine the outcome of the appeal; provide oversight… more
- Elevance Health (Olathe, KS)
- … with all legislative and regulatory requirements. This position will be supporting our new Kansas Medicaid health plan . The role will focus on Value-Based ... within 50 miles of one of our Elevance Health PulsePoint locations in Kansas . The **Provider Contract Consultant** creates and manages contract templates used across… more
- The Cigna Group (Nashville, TN)
- …we further extend our operations serving a variety of Medicare Advantage, Medicaid , and Commercial clients. **Duties & Responsibilities:** + Perform home visits with ... delivered. + Coordinate with patient's other providers including PCP, specialists and health plan case managers to ensure all are working together with the patient… more
- The Cigna Group (St. Louis, MO)
- …Health Care Administration or Business + At least one year experience in a health plan or PBM setting. Medicare, Medicaid and Marketplace experience a plus. + ... accountabilities associated with all regulated lines of business including Medicare, Medicaid , and Marketplace (Exchange / Health Care Reform). The team supports… more
- Intermountain Health (Murray, UT)
- …departments, as well as local, state and federal programs (Medicare, Medicaid , etc.) + Reviews outpatient pre-authorization requests and/or retrospective requests ... the development and maintenance of policies and procedures to ensure regulatory compliance , identifying new policies and procedures that are required. Complies with… more
- Intermountain Health (Las Vegas, NV)
- …with disabilities to perform the essential functions. + Knowledge of CMS Medicare, Medicaid , Managed Care and Commercial health plan billing, reimbursement and ... care, financial modeling, strategic planning and marketing. + Knowledge of compliance , practice briefs, white papers, and other publications guiding ethical and… more
- The Cigna Group (Bloomfield, CT)
- …patient's family on chronic medical conditions, preventative care, and medication adherence compliance ; + Perform urgent care visits in the home and telephonically ... multidisciplinary team which may include: patients' PCPs and health plan case managers; + Sharing after hour on-call coverage...+ Must be able to be credentialed by Medicare, Medicaid , and other Private Insurance Companies + Experience with… more
- The Cigna Group (Bloomfield, CT)
- …+ Close gaps and barriers to medication adherence and assisting customers with compliance of 90-day refill rates versus 30-day, driving utilization of home delivery ... of chronic condition/population health management. + Direct Managed Care Health Plan and/or Pharmacy Benefit Manager (PBM) experience + Strong understanding of… more
- Peak Vista (Colorado Springs, CO)
- …and highest quality service. + Demonstrates knowledge of and adherence to the Compliance Plan and conflict of interest requirements. + Enhances the ... Our service area covers 14 counties, from the front range to the Kansas border, with locations throughout Colorado Springs, Fountain, Flagler, Divide, Limon, and… more
- Peak Vista (Colorado Springs, CO)
- …and highest quality service. + Demonstrates knowledge of and adherence to the Compliance Plan and conflict of interest requirements. + Enhances the ... Our service area covers 14 counties, from the front range to the Kansas border, with locations throughout Colorado Springs, Fountain, Flagler, Divide, Limon, and… more
- The Cigna Group (KS)
- …Care (PAC) medical utilization assignments including the monitoring of compliance trends during secondary reviews. Analyzes operating Organization Determinations, ... times are met. Adheres to Centers for Medicare and Medicaid Services regarding state contractual policies and procedure requirements....to be eligible to participate in an annual bonus plan . We want you to be healthy, balanced, and… more
- Elevance Health (KS)
- …The ideal candidate will live within 50 miles of one of our Kansas Elevance Health PulsePoint locations. The **Strategic Vendor Consultant** is responsible for ... success measures. + Manages the execution of vendor agreements to ensure compliance , monitor quality, and develop corrective action plans. + Responsible for managing… more
- Marshfield Clinic (Marshfield, WI)
- …Manager serves as part of the collaborative care team, addressing the patient's plan of care and expected outcomes with special attention being given to progression ... **Alabama** **Alaska** **Arkansas** **Florida** **Georgia** **Idaho** **Illinois** **Indiana** **Iowa** ** Kansas ** **Kentucky** **Michigan** **Minnesota** **Mississippi** **Missouri** **Nebraska** **North Carolina**… more