- Humana (Lansing, MI)
- …but not limited to pharmacy provider manuals for Medicare and Medicaid , policy documents, pharmacy communications, regulatory contract compliance, and other ... but not limited to pharmacy provider manuals for Medicare and Medicaid , policy documents, pharmacy communications, regulatory contract compliance, and other… more
- Humana (Lansing, MI)
- …Contract Load Professional and play a pivotal role in supporting the Wisconsin Medicaid market. In this dynamic position, you will ensure the accuracy and integrity ... contributing to the seamless delivery of healthcare services across Medicare DSNP, Medicaid , and Long Term Care programs. You will collaborate with cross-functional… more
- Molina Healthcare (Sterling Heights, MI)
- …the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Facilitates comprehensive research and ... coordination of benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of… more
- Humana (Lansing, MI)
- …years of healthcare process improvement experience or project management, or operations ( Medicaid preferred) + 3+ years of experience in the healthcare industry. + ... focused on continuously improving consumer experiences **Preferred Qualifications** + Medicaid experience with provider functions, which may include contracting,… more
- Molina Healthcare (Sterling Heights, MI)
- …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
- Prime Therapeutics (Lansing, MI)
- …client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid ) + Other duties as assigned **Education & Experience** + Bachelor's ... within a highly regulated industry, including experience with Medicare, Medicaid , and the Affordable Care Act (ACA) + Must...study, such as Juris Doctor + Medicare Part D, Medicaid , and/or Affordable Care Act knowledge and experience **Physical… more
- Humana (Lansing, MI)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- Humana (Detroit, MI)
- …assigned area in Wayne or Macomb county, to conduct in home visits with Medicare/ Medicaid members.** The Field Care Manager Nurse 2 employs a variety of strategies, ... + Experience with health promotion, coaching and wellness + Experience with Medicaid Long Term Care + Previous managed care experience + Bilingual- Spanish,… more
- Humana (Detroit, MI)
- …assigned area in Wayne or Macomb county, to conduct in home visits with Medicare/ Medicaid members.** **Must reside in Michigan with the ability to drive to Wayne or ... + Experience with health promotion, coaching and wellness + Experience with Medicaid Long Term Care + Previous managed care experience + Bilingual- Spanish,… more
- Humana (Lansing, MI)
- …and help us put health first** The Senior Data and Reporting Professional ( Medicaid - Michigan) generates ad-hoc reports and regular datasets or report information ... database or data warehouse queries and scripts supporting Humana's Michigan Medicaid plan network optimization. The Senior Data and Reporting Professional integrates… more
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