- Molina Healthcare (Grand Rapids, MI)
- …**Job Summary** Responsible for being the SME (Subject Matter Expert) for Medicaid risk adjustment programs in multiple states. Maintain risk adjustment model, ... available to lead national risk adjustment studies. Prior experience in Medicaid risk adjustment is not required. **KNOWLEDGE/SKILLS/ABILITIES** + Analyze risk score… more
- Molina Healthcare (Ann Arbor, MI)
- …and clinical performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **JOB QUALIFICATIONS** ... + 3 - 5 years supervisory experience + Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans + Experience with Databricks… more
- Molina Healthcare (Ann Arbor, MI)
- …and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Manages staff responsible for the submission/resolution of ... member and provider inquiries, appeals and grievances for the Plan. Ensures resolutions are compliant. + Proactively assesses and audits business processes to determine those most effective and efficient at resolving member and provider problems. + Serves as… more
- Molina Healthcare (Ann Arbor, MI)
- **JOB DESCRIPTION** **Job Summary** Responsible for analysis of Medicaid and Medicare financial reports, trend, and opportunities. Includes evaluation of and ... recommendations relating to business opportunities, Medicare bids, investments, financial regulations, and similar financial projects or programs. Duties include gathering, interpreting, and evaluating financial information across the organization; generating… more
- Molina Healthcare (Grand Rapids, MI)
- …+ 5-7 years of product development experience. + Managed Care (specifically Medicaid ) experience. + Experience working in a cross functional highly matrixed ... organization. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal… more
- Tenet Healthcare (Detroit, MI)
- Patient Management Clerical Associate Full Time Evenings Child Medicaid - 2506002384 Description : Children's Hospital of Michigan is an international leader in ... pediatric and adolescent medicine. Surgical services include general, thoracic, reconstructive and cardiovascular. Imaging technology designed specifically for children provides advanced diagnostic services including Positron Emission Tomography (PET) and MRI.… more
- Molina Healthcare (Detroit, MI)
- …**Job Summary** Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management ... includes estimating, scheduling, costing, planning, and issue/risk management. **KNOWLEDGE/SKILLS/ABILITIES** + Proven depth of understanding and demonstrable results for effective management of intermediate to large-scale projects, using prescribed… more
- State of Michigan (Grand Rapids, MI)
- …of reimbursement. The purpose is to satisfy the federal mandate for auditing Medicaid Providers and to ensure that the provider's reimbursement is in accordance with ... the rules and regulations governing the State Medicaid Reimbursement Programs and Procedures. The work requires the...07 Do you have a working knowledge of the Medicaid Long Term Care Program, Medicaid and… more
- CVS Health (Lansing, MI)
- …lost funds, and to comply with state regulations mandating fraud plans and reporting; Medicaid experience is preferred. Leads a team in the planning and execution of ... 3 years of experience in a Healthcare Program Integrity, Medicaid Special Investigation or Medicaid / Medicare / Commercial Compliance role + Strong verbal… more
- Molina Healthcare (Sterling Heights, MI)
- …Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits, ... Care Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare, or equivalent combination of relevant education and experience… more