- 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
- KBR (Sioux Falls, SD)
- …storytelling and data visualization. + Experience editing and publishing content via a content management system . + Ability to work independently as well ... have real, everyday impact. Essential Job Functions: + Craft compelling content -articles, headlines, and social media posts-that enhance public understanding of the… more
- Humana (Pierre, SD)
- …participation in hearings involving an Administrative Law Judge, support for CMS audits, cross-functional team activities, and other responsibilities as determined ... and work is assisted by diverse resources, included but not limited to CMS policies, National and Local Coverage Determinations, CMS -recognized Compendia, NCCN,… more
- Humana (Pierre, SD)
- …you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus on our 5+ ... To succeed in this position, you will need to be well versed in CMS knowledge of outpatient, inpatient and appeal criteria including regulation and policies. You… 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)
- …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
- CVS Health (Pierre, SD)
- …codes that are submitted to the Centers for Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes are appropriate, accurate, and ... process audits to ensure compliance with internal policies and procedures and existing CMS regulations. + Ability to work independently as well as in a cross… 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
- 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
- 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