- Molina Healthcare (Grand Rapids, MI)
- …Google or Adobe analytics (or similar) Google AdWords, Tag Manager systems, (Adobe or Google) CMS ( content management system ) Google Ads SEO, SEM, CRM ... and incorporate learnings to drive continuous improvements + Create promotional and content strategies to expand digital reach + Collaborate on developing content… more
- Humana (Lansing, MI)
- …and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual ... Medicare /Medicaid and Waiver requests. The Medical Director provides medical...other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some… more
- University of Michigan (Ann Arbor, MI)
- …of care which operates under the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS). The PPS Coordinator oversees all aspects of data collection ... Facility Patient Assessment Instrument (IRF-PAI) in accordance with Centers for Medicare and Medicaid Services. This individual utilizes specialty knowledge of IRF… more
- CVS Health (Lansing, MI)
- …researching and resolving Medicare complaints received via the Centers for Medicaid and Medicare Services ( CMS ). In this role, you will manage a queue of ... Medicare knowledge/experience + Prior experience with complaints and/or Center for Medicare and Medicaid Services ( CMS ) + Medical/RX claim processing… more
- Humana (Lansing, MI)
- …team to assist and facilitate new hires and remediation of medical directors performing Medicare utilization management processes and be the liaison for the ... key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with...or nurse, with a focus on our 5+ million Medicare members. You will also facilitate the delivery of… more
- Corewell Health (Grand Rapids, MI)
- …leaders across the enterprise (eg, Medical Directors, Quality Improvement, Utilization Management , Care Management , Medicare Product Development, Claims, ... receiving LTSS. It also ensures that LTSS operations align with the integration of Medicare and Medicaid benefits under Michigan's HIDE SNP model, meeting CMS … more
- Humana (Lansing, MI)
- …community and help us put health first** The Encounter Data Management Professional develops business processes to ensure successful submission and reconciliation ... of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards via analysis of data, and develops tools to… more
- CVS Health (Lansing, MI)
- …(if applicable) to ensure the ICD codes that are submitted to the Centers for Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes ... 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
- Ensono (Detroit, MI)
- …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
- Humana (Lansing, MI)
- …Humana's Clinical Leadership teams to ensure utilization reviews comply with Centers for Medicare & Medicaid Services ( CMS ) regulations as well as Michigan Dual ... our caring community and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and independent critical… more