- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and ... techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** Health Quality and Stars (HQS) is an organization that is responsible for improving ... health outcomes and advancing the care experience of our...quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** Health Quality and Stars (HQS) is an organization that is responsible for improving ... health outcomes and advancing the care experience of our...quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system… more
- Prime Therapeutics (Columbus, OH)
- …participates inclient and stakeholder meetings + Reviews proposedfederal and state public policy and rule changes and prepares position papers for internal and ... client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid ) + Other duties as assigned **Education & Experience** + Bachelor's… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** Health Quality and Stars (HQS) is an organization that is responsible for improving ... health outcomes and advancing the care experience of our...quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system… more
- Molina Healthcare (Akron, OH)
- …director, and quality improvement staff. + Facilitates conformance to Medicare, Medicaid , NCQA and other regulatory requirements. + Reviews quality referred issues, ... license without restrictions to practice and free of sanctions from Medicaid or Medicare. **PREFERRED EDUCATION:** Master's in Business Administration, Public … more
- Stark County Board of Developmental Disabilities (Canton, OH)
- …video, in-person or other contact to aid in the development of outcomes that ensure health and welfare to help the person live their best life; + Ensures that ... with State Rules and Regulations as well as Board Policy ; + Follows up with service providers to assure...subpoena, billable TCM notes are billed to the individual's Medicaid ; + Adheres to work assignment timelines, including TCM… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate about contributing to… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Senior Process Improvement Professional is an autonomous, strategic thinker that works ... and implement quality controls. + Analyze, interpret, and display financial, health , competitive, and performance measurement data and use insights to optimize… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products + Must be passionate about contributing to an… more