- Elevance Health (Grand Prairie, TX)
- … Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services ( CMS ) division of the Department of Health ... member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services… more
- Humana (Austin, TX)
- … management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial ... health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve… more
- Molina Healthcare (TX)
- …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 (Austin, TX)
- …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
- Texas Health Resources (Arlington, TX)
- … Medicare /Medicaid regulations. + Leads resolution of reimbursement issues for Medicare /Medicaid and represents System hospitals in negotiations with the ... in safety net funding opportunities in programs promulgated by CMS and TxHHSC. The programs include 1115 Waiver or...risk. + Oversees the timely filing of regulatory enrollment, Medicare /Medicaid cost reports for all wholly owned system… more
- Humana (Austin, TX)
- …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
- BAYADA Home Health Care (Austin, TX)
- …for quality and adherence to policies and procedures. As a member of the Medicare Case Management (MCM) office, individuals in this role are expected to ... to the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each… more
- Humana (Austin, TX)
- …gaps. They will work closely with established functions inside utilization management (Medical Director, clinician decision making teams, quality audits, prior ... clinical criteria. as appropriate works closely with Clinical Risk Management to support enterprise MD speaker readiness for external...and overseeing the plan for MD speaker engagement in CMS program audits** + Work closely with Clinical Risk… more
- Humana (Austin, TX)
- …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
- Elevance Health (Houston, TX)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... a BA/BS degree and a minimum of 5 years of audit/reimbursement or related Medicare experience; or any combination of education and experience, which would provide an… more