- US Tech Solutions (TX)
- …for this position. **Skills:** + MUST HAVE MANAGED CARE exp and Medicare /Medicaid knowledge. + MUST HAVE 6 months of experienced with Prior Authorization(required). ... + MUST HAVE experience with Medicare Part D + Must Have Pharmacy Benefit Management (PBM) experience. **Education:** + Pharm D. required with at least two years… more
- Kelsey-Seybold Clinic (Humble, TX)
- …commercial health plans. KelseyCare Advantage (https://www.kelseycareadvantage.com/) , a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated ... Clinic, has achieved the coveted 5-out-of-5-star rating from the Centers for Medicare and Medicaid for six consecutive years. Kelsey-Seybold has been recognized by… more
- Kelsey-Seybold Clinic (Katy, TX)
- …and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated with ... achieved an overall rating of 5-out-of-5-stars as part of the Centers for Medicare and Medicaid CMS annual assessment for eight consecutive years, including 2024.… more
- Abbott (Plano, TX)
- …+ General knowledge of private insurance, Worker's Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review. Some ... **Qualifications** + Knowledge of private insurance, Worker's Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review. +… more
- Humana (Austin, TX)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medicare Advantage experience + Strong Communication Skills + Ability to ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Evolent (Austin, TX)
- …current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the ... Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare . . No history of disciplinary or legal action by a state medical… more
- Kelsey-Seybold Clinic (Houston, TX)
- …and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated with ... achieved an overall rating of 5-out-of-5-stars as part of the Centers for Medicare and Medicaid CMS annual assessment for eight consecutive years, including 2024.… more
- Cognizant (Austin, TX)
- …and member onboarding for individual, group, and government-sponsored health plans ( Medicare , Medicaid, ACA), ensuring compliance with CMS, ACA, and other regulatory ... sales and enrollment processes for individual, group, and government-sponsored health plans ( Medicare , Medicaid, ACA). . Strong understanding of CMS, ACA, and other… more
- Cognizant (Austin, TX)
- …and member onboarding for individual, group, and government-sponsored health plans ( Medicare , Medicaid, ACA), ensuring compliance with CMS, ACA, and other regulatory ... sales and enrollment processes for individual, group, and government-sponsored health plans ( Medicare , Medicaid, ACA). * Strong understanding of CMS, ACA, and other… more
- Molina Healthcare (TX)
- …for Quality Assurance (NCQA)/Healthcare Effectiveness Data Information Set (HEDIS)/ Medicare STARS). * Excellent organizational and time-management skills. * ... Quality (CPHQ) or other health care or management certification. * Medicaid/ Medicare population experience. * Clinical experience. * Familiarity and experience with… more