- Humana (Phoenix, AZ)
- …other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how ... includes some experience in an inpatient environment and/or related to care of a Medicare or Medicaid type population + Current and ongoing Board Certification in an… more
- Sedgwick (Phoenix, AZ)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Medicare Compliance Sr **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, ... review, and analysis and interpretation of interventions for the preparation of Medicare Set-Aside allocations. **ARE YOU AN IDEAL CANDIDATE?** We are looking for… more
- Molina Healthcare (Scottsdale, AZ)
- …and due-date logic * Proven history of building-or running-real-time dashboards that keep case aging within SLA * Demonstrated skill in root-cause triage that routes ... Quality, and Operations to fund high-return enhancements. **Core** ** ** **Duties** 1. Case Audits - Run scheduled and ad-hoc audits across internal and delegated… more
- Molina Healthcare (Chandler, AZ)
- …the performance of prior authorization, inpatient concurrent review, discharge planning, case management and interdisciplinary care team activities. + Ensures that ... License without restrictions (free of sanctions from Medicaid or Medicare ) **PREFERRED EDUCATION:** Master's in Business Administration, Public Health, Healthcare… more
- CVS Health (Phoenix, AZ)
- …various life and work situations. + Appropriately documents member interactions and research/ case fulfillment in the system. + Works in an inbound and outbound ... + 1+ year(s) experience in social work, social services, or case management field. + Private, confidential workspace free from distractions.professional,… more
- Molina Healthcare (Tucson, AZ)
- …to AVP, VP and senior management + Consultative role, develops business case methodologies for programs, develops and coordinates implementation of business strategy ... + Collaborates and facilitates activities with other units at corporate and Molina Plans. **JOB QUALIFICATIONS** **Required Education** Bachelor's degree or equivalent combination of education and experience **Required Experience** 7-9 years **Preferred… more
- Humana (Phoenix, AZ)
- …complex to complex issues where the analysis of situations or data requires a case -by- case consideration of the Medicare rules, Humana policies and medical ... Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical...to support optimal value based care in accordance with Medicare and Humana policy. The Medical Director will collaborate… more
- Banner Health (Tucson, AZ)
- **Primary City/State:** Tucson, Arizona **Department Name:** Case Mgmt-Hosp **Work Shift:** Day **Job Category:** Clinical Care The future is full of possibilities. ... a healthy work-life balance. As the Registered Nurse RN Case Manager Care Coordination, you will have the opportunity...across the continuum of care. 4. Maintains knowledge of Medicare , Medicaid and other program benefits to assist patients… more
- Banner Health (Mesa, AZ)
- **Primary City/State:** Mesa, Arizona **Department Name:** Case Mgmt-Hosp **Work Shift:** Day **Job Category:** Clinical Care Better Than Ever for Nurses. At Banner ... experiences - better nursing. As a RN Registered Nurse Case Manager of Care Coordination, you will contribute your...across the continuum of care. 4. Maintains knowledge of Medicare , Medicaid and other program benefits to assist patients… more
- CVS Health (Phoenix, AZ)
- …comprised of network management, clinical coverage, and policies. Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care ... and healthcare personnel as appropriate. - Implements and coordinates all case management activities relating to catastrophic cases and chronically ill… more