- Carrington (Pierre, SD)
- …vendor ongoing reviews and annual contract obligations and ensure accuracy of vendor management system and timely vendor notifications as needed. + Escalate ... to ensure compliance and submit to FNMA/FHLMC for approval. Update vendor management system and notify internal stakeholders of any changes to approval status. +… more
- Baylor Scott & White Health (Pierre, SD)
- …+ Creates and edits webpages using customizable components and basic HTML within Sitecore content management system + Operates within the principles of ... Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well....Experience building and optimizing web pages using digital and content management systems + Forward thinking, resourceful… more
- Highmark Health (Pierre, SD)
- …Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, state, CMS ... departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes...not limited to NIST, HITRUST, PCI, HIPAA, SOC, MAR, CMS , JCAHO, in order to identify, assess, prioritize, evaluate… more
- Humana (Pierre, SD)
- …by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, ... of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise from inpatient or post-acute care… more
- Datavant (Pierre, SD)
- …combines strategic thinking, clinical product development expertise, and people management responsibilities. You'll be accountable for ensuring our products deliver ... customer outcomes, regulatory drivers, and market trends in risk adjustment, care management , and provider enablement. + Identify and prioritize use cases that… more
- CenterWell (Pierre, SD)
- …and Medicare payment model programs via the Center for Medicare and Medicaid Services ( CMS ), such as ACO REACH, MSSP, and future models. Under general direction and ... Medicare, population health, Accountable Care Organizations (ACOs), medical group management / practice management , health plans /...and inform of necessary / required actions initiated by CMS * Oversee rules and regulations of ACO programs… more
- Ensono (Pierre, SD)
- …Interchange (EFI), Next Generation Desktop (NGD), Electronic File Interchange (EFI), and the CMS Identity Management System (IDM). **Why Ensono?** Ensono is ... and FIPS 140-2, as applicable. + Maintain and renew certifications required for system access and management , ensuring continued compliance and eligibility. +… more
- Intermountain Health (Pierre, SD)
- …schedules, and related functions. This position is adept with Federal, State, CMS -OPPS, and regulatory/payer requirements and will update the chargemaster as needed. ... related to chargemaster for community connects, EPMO projects, Enterprise and system initiatives. + Performs annual review of chargemaster with clinical operations… more
- Prime Therapeutics (Pierre, SD)
- …Makes business decisions that have impacts on members, providers, Part D plans, CMS , and the company. Requires a working knowledge of Medicare Part D eligibility ... Part D operations are successful, efficient, auditable and in compliance with CMS requirements. **Responsibilities** + Ensures the accuracy of payments to Part D… more
- Humana (Pierre, SD)
- …help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual ... by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.… more