- Apex Health Solutions (Houston, TX)
- …technicians) in all aspects of pharmacy operations and services including Medicare part D oversight, coverage determination and re-determination (appeal) process, ... experience or other work experience in an equivalent background such as Medicare Part D program. Certificates and Licenses: Current, unrestricted Certified Pharmacy… more
- CenterWell (Austin, TX)
- …quality and cost improvement for high-risk senior populations in full risk Medicare arrangements. This individual will help assess the value of each opportunity ... quality and value drivers in full risk care delivery, ideally in Medicare /seniors + Demonstrated ability to work collaboratively with clinical and operational… more
- Abbott (Plano, TX)
- …+ General knowledge of private insurance, Worker's Compensation and Medicare guidelines pertaining toProspective and Retrospective Utilization Review. Some ... **Qualifications** + Knowledge of private insurance, Worker's Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review. +… more
- Sedgwick (Irving, TX)
- …limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests ... principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. + Excellent oral… more
- Molina Healthcare (Austin, TX)
- …Performs analysis across multiple states and lines of business ( Medicare , Medicaid, Marketplace ACA). **KNOWLEDGE/SKILLS/ABILITIES** + Compiling and organizing ... in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS model… more
- Insight Global (Richardson, TX)
- …Project Manager to work on regulatory and compliance projects tied to medicare /medicaid inititiaves. - Direct and coordinate resources to ensure project progressed ... calls and providing updates to senior leaders Experience on projects related to medicare /medicaid null We are a company committed to creating diverse and inclusive… 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
- Texas Health Resources (Stephenville, TX)
- …aspects of each treatment session in accordance with departmental, JCAHO, Medicare , and other applicable regulatory guidelines. + documents assessments of education ... patient understanding of education provided in accordance with departmental, JCAHO, Medicare , and other applicable regulatory guidelines. **Why Texas Health** At… more
- MD Anderson Cancer Center (Houston, TX)
- …the laboratory in which he/she is working complies with the CAP, JCAHO, FDA, Medicare , and CLIA regulations for accreditation. . Must be able to identify and solve ... service. Administrative . Must assure compliance with standards of CAP, JCAHO, FDA, Medicare , and CLIA. . Must give theoretical guidance and technical assistance to… more
- Molina Healthcare (Fort Worth, TX)
- …performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **Job Qualifications** **Required ... of related experience in healthcare + Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans + Analytical work experience within the… more