- UTMB Health (Galveston, TX)
- …and estimates and ensures UTMB compliance with Medicare and Medicaid regulations. **Scope:** Institutional **Responsibilities:** + Responsible for technical aspects, ... calculations and analyses of multiple areas of Medicare and Medicaid reimbursement components including, but not limited to, cost report preparation, audits,… more
- CVS Health (San Antonio, TX)
- …oversight of SIU and Fraud, Waste and Abuse activities related to TX Medicaid and CHIP programs. Oversees activities related to the prevention, investigation, and ... comply with state regulations mandating fraud plans and reporting; Medicaid experience is preferred. Leads the team in the...3 years of experience in a Healthcare Program Integrity, Medicaid Special Investigation or Medicaid / Medicare… more
- CVS Health (Austin, TX)
- …actionable insights to support fraud, waste, and abuse (FWA) detection and Medicaid regulatory & compliance reporting. This is an individual contributor role. Job ... data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate Medicaid … more
- Humana (Austin, TX)
- …Professional who will play an integral role as part of Humana's National Medicaid Operations team. This position will lead the development of member-facing materials ... to support our new and existing Medicaid markets. The Creative Development Professional will work to...work to develop digital member-facing materials needed to support Medicaid 's communication and program goals and objectives. They will… more
- Humana (Austin, TX)
- …reference sources. Medical Directors will learn Medicare, Medicare Advantage, and Medicaid requirements and will understand how to operationalize this knowledge in ... professionals are in agreement with national guidelines, CMS and state Medicaid requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- Prime Therapeutics (Austin, TX)
- …oversees contracting, rate generation, reporting, and deliverables for State Medicaid supplemental rebate programs. This role collaborates with internal departments ... and external partners, including State Medicaid Programs and pharmaceutical manufacturers, to ensure strategic objectives and contractual obligations are met. This… more
- Humana (Austin, TX)
- …health first** The Senior Acquisition Implementation Professional manages all aspects of Medicaid State Implementations, from start to finish, so that it is ... internal stakeholders. The Senior Acquisition Implementation Professional manages all aspects of Medicaid State Implementation, from start to finish, so that it is… more
- Health Care Service Corporation (Richardson, TX)
- …development. **Job Summary** This position is responsible for directing the Medicaid pharmacy operations team and responsible for analyzing and optimizing the ... Direct and manage the ongoing assessment and program maintenance updates for the Medicaid pharmacy operations program. In addition, assess, direct and manage to the… more
- Humana (Austin, TX)
- …conferences, and other reference sources. Medical Directors will learn Medicare, Medicaid , and Medicare Advantage requirements and will understand how to ... of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/… more
- Actalent (Austin, TX)
- …CST; overtime as needed; weekends and holidays on a rotation basis Business Unit: Medicaid About the Role We are seeking a Clinical Review Nurse to perform ... concurrent reviews for Medicaid members, ensuring appropriate care, medical necessity, and discharge planning in alignment with clinical policies and guidelines.… more