- Humana (Phoenix, AZ)
- …and demographic diversity. **Preferred Qualifications** + Special Needs Plan (SNP) in Medicare and/or Medicaid + Medical Social Work experience + Experience working ... advocating for managed care members at all levels of care. + Non-clinical Case Management experience + Call Center Experience + Experience working remotely (WAH)… more
- Evolent (Phoenix, AZ)
- …interventional cardiology to help ensure the delivery of high-value, evidence-based case reviews. Enjoy improved work-life balance while contributing to better ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- CVS Health (Phoenix, AZ)
- …Assigns reviews to Medical Directors and enters all data related to appeals and case reviews into a database. + Participates in data and analysis of reports ... audits. + Consults with manager on complex cases and interfaces with case managers, clinical supervisors, and other personnel in resolving appeals. + Responds… more
- Sanofi Group (Phoenix, AZ)
- …to coordinate activities in support of patient access + Partner with Field Sales, Case Management and Market Access teams to ensure FRMs are working in close ... specialty product experience (ie medical benefit coverage) + 5-10 years of prior case management experience or healthcare experience + 5-10 years of prior field… more
- Molina Healthcare (Tucson, AZ)
- …and adherence to appropriate guidelines and support staff who have an ongoing member case load for regular outreach and management. + As a Lead RN provide support, ... HCS Department staff workload for adherence to the Policies, Procedures, Guidelines, Medicare Model of Care, and deadlines. Assures oversight and direction of… more
- Cordis (AZ)
- …and Associate Territory Manager to achieve daily sales objectives through case support and product in-servicing. Responsible for direct revenue generation ... (transactional Business) through direct case support. Reports to National Clinical Sales Director. **Responsibilities** + Responsible for meeting revenue generation… more
- Banner Health (AZ)
- …of accounts for specific patient types and specialties in combination with the Case Mix Index and case financial information to formulate productivity standards, ... and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health… more
- HonorHealth (AZ)
- …Responsible for coordinating and conducting medical necessity reviews for all Medicare , AHCCCS, Self-pay, and all other payers, upon admission and concurrently ... (such as timeliness and appropriateness of services). Collaborates with physicians, case managers, payers and others to appeal individual denials and trended… more
- Banner Health (Phoenix, AZ)
- …paperwork faxed to PBO. Adheres to all billing procedures including preparation of Medicare billing at the end of the month within specific timelines. 3. Responsible ... offices, third party payors, vendors, clinical staff, ancillary staff, therapist, nurses and case managers. Also interacts with physician in order to report and ask… more
- Banner Health (Mesa, AZ)
- …appropriately and not feeling "alone" in the field! We recognize that our nurse case managers are the key to a successful journey with home health. Banner Home ... measures better than the national and Arizona average in almost all Medicare Quality Compare patient satisfaction results. POSITION SUMMARY This position assesses,… more