- CVS Health (Lansing, MI)
- …Lean Six Sigma (Green/Black Belt) - Tableau Dashboards/Analytics -Medicare / Medicaid experience -Experience with HEDIS Metrics, CAHPS Member Satisfaction Surveys, ... NCQA Accreditation, Compliance Audits and/or MI State Reporting / Compliance **Education** . Bachelor's degree or equivalent managed care experience… more
- CVS Health (Lansing, MI)
- …role is a telephonic clinical case management position working with our Medicaid population. Use of Motivational Interviewing skills, members are outreached and ... goals * Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.… more
- CVS Health (Lansing, MI)
- …issues. + Manages operational aspects of the team (eg, budget, performance, and compliance ), and implements workforce and succession plans to meet business needs. + ... of 3 years managing/leading a team. + Experience working in Medicare, Medicaid , or Commercial Health Insurance. **Preferred Qualifications** + Experience working in… more
- Munson Healthcare (Manistee, MI)
- …EOC, EM and Life Safety standards, The Centers for Medicare and Medicaid Services (CMS) requirements, Michigan Occupational Safety and Health Administration (MIOSHA) ... safety and environment of care, security and emergency management.Oversees and manages compliance with all applicable regulations including but not limited to TJC,… more
- Molina Healthcare (Detroit, MI)
- …and supervision of daily functional operations to insure compliance to contract requirements. **Knowledge/Skills/Abilities** * Oversees budget responsibilities ... type management responsibility. 5 years progressive experience supporting a Medicaid ,.Medicare and Marketplace or large claims processing environment with… more
- Molina Healthcare (Ann Arbor, MI)
- …our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing. This role ... will focus on identifying, reviewing, and validating Medicaid secondary payments to ensure alignment with internal configuration rules and regulatory guidance. The… more
- Molina Healthcare (Sterling Heights, MI)
- …complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination, ... tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met...that drive measurable improvement. + Partners with finance and compliance to develop business cases and support reporting that… more
- Humana (Lansing, MI)
- …other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the same day. ... in special projects as assigned by your Supervisor or Manager . **Use your skills to make an impact** **Required...to help people with Medicare, or both Medicare and Medicaid , achieve their best possible health and wellness through… more
- CenterWell (Lansing, MI)
- …experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + ... degree in a related field + Experience with Florida Medicaid + Experience with Physical Therapy, DME, Cardiac or...of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing… more
- Corewell Health (Watervliet, MI)
- …IRF-PAI tool including transmission of records to the Centers for Medicare and Medicaid Services (CMS) and other insurances as needed. Monitor and educate clinicians ... on documentation quality and compliance to improve clinical outcomes, and maximize reimbursement. Collaborate with coding, billing, denials and other departments as… more