- Cadmus (Pierre, SD)
- …part of our DevOps team supporting one of our federal programs. Multi-year CMS contract. This candidate will design, automate, and maintain cloud infrastructure on ... rules. + Write and troubleshoot F5 iRules for traffic management and integration use cases. + Ensure adherence to...and integration use cases. + Ensure adherence to all CMS security, compliance, and governance requirements. + Support application… more
- Humana (Pierre, SD)
- …assisted by diverse resources, which may include national clinical guidelines, CMS and state policies and determinations, clinical reference materials, internal ... of decisions to internal associates, and possible participation in care management . May occasionally participate in discussions with external physicians by phone… more
- Humana (Pierre, SD)
- …by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, ... by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- ASM Research, An Accenture Federal Services Company (Pierre, SD)
- …are handled according to contractual service standards and document all cases in the Case Management System ( CMS ). + Performs call follow-up and reporting as ... Cyber Awareness and PII to ensure access to the CMS system is maintained. **Minimum Qualifications** +...to type 50 wpm + Excellent organization and time management skills + Comply with all HIPAA regulations +… more
- ASM Research, An Accenture Federal Services Company (Pierre, SD)
- …meet call center target metrics + Ensures complete and accurate documentation in case management system ( CMS ) + Assists direct reports to deescalate callers, ... Cyber Awareness and PII to ensure access to the CMS system is maintained **Minimum Qualifications** +...to type 50 wpm + Excellent organization and time management skills + Comply with all HIPAA regulations +… more
- Highmark Health (Pierre, SD)
- …SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current ... be required. The incumbent ensures compliance to NCQA, URAC, CMS , DOH, and DOL regulations at all times. In...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Humana (Pierre, SD)
- …by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, ... provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases)… more
- Cognizant (Pierre, SD)
- …and government-sponsored health plans (Medicare, Medicaid, ACA), ensuring compliance with CMS , ACA, and other regulatory requirements. **Work Model:** We strive to ... field. * 5+ years of experience as a Product Owner or in product management within healthcare or insurance domains. * Hands-on experience with sales and enrollment… more
- Carrington (Pierre, SD)
- …financial and loss analysis including ability to determine: all funds/advances due CMS have been recovered. + Moderate ability to conduct quality assurance reviews. ... MS Word, Excel. + Strong attention to details and excellent time management and organizational skills. + Comprehensive writing skills, including proper punctuation… more
- Cardinal Health (Pierre, SD)
- …audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories as well as ... and recommendations; presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records. +… more