- Humana (Austin, TX)
- …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 (Austin, TX)
- …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 (Austin, TX)
- …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
- Citigroup (Irving, TX)
- …Systems (TPS) within the z/Transaction Processing Facility (z/TPF) operating system . Collaborate with business representatives to understand the functionality ... functional design and code using C, C++ and Sabre-Talk languages, z/TPF database management and hierarchical Database properties, IBM TPF Toolkit IDE, and VM CMS… more
- Insight Global (Austin, TX)
- …team. This role involves working on high-priority projects related to CMS regulatory requirements, including hip and knee surgery scheduling and post-surgery ... and maintain backend APIs for clinical transformation projects. * Work on CMS regulatory requirement projects, including hip and knee surgery scheduling. * Integrate… more
- ASM Research, An Accenture Federal Services Company (Austin, TX)
- …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 (Austin, TX)
- …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
- Cognizant (Austin, TX)
- …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
- Houston Methodist (Houston, TX)
- …patients, receiving coaching from experienced Transplant Coordinators and management , benefiting from their practice. The Post-Transplant Coordinator position ... accurate data for hospital-based statistics and regulatory agencies such as OPTN/UNOS/ CMS and Medicaid to ensure compliance with all governmental reporting… more
- Humana (Austin, TX)
- …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