- Molina Healthcare (MI)
- …and the site of service. This position will be supporting our Washington State Medicare plan. We are seeking a candidate with previous Case Management experience ... of MS Suite, organized and analytical thinking. Experience with Medicare /Medicaid, MS 365 and familiarity with claims is highly...365 and familiarity with claims is highly preferred. The Case Manager must be able to work in a… more
- Humana (Lansing, MI)
- …includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board ... experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute… more
- Molina Healthcare (Grand Rapids, MI)
- …for overseeing all aspects of healthcare subrogation operations across Medicaid, Medicare , and Marketplace lines of business. This includes direct management of ... role requires experience across a wide range of subrogation case types-including automobile-related claims (eg, no-fault/PIP), workers' compensation, general… more
- Molina Healthcare (MI)
- …Opportunity for a Texas licensed RN to join Molina to work with our Medicare members in the San Antonio service delivery area; candidates should reside in Bexar ... will be given to those candidates with previous experience working with the Medicare population within a Managed Care Organization (MCO). Mileage is reimbursed as… more
- Molina Healthcare (Battle Creek, MI)
- …RN license in the state of MI. This position will support our MMP (Medicaid Medicare Population) will be supporting DSNP. This position will have a case load ... Nurses who have experience working with manage care population and/or case management role. Excellent computer skills and diligence are especially important… more
- Corewell Health (Grosse Pointe, MI)
- …information, educating and providing information as necessary. Collects and documents Medicare Questionnaire, issue Medicare Inpatient Letter & Medicare ... Performs medical necessity check and issue ABN as appropriate for Medicare primary outpatients. Note: excluding lab-only outpatients effective September. + Affix… more
- Humana (Lansing, MI)
- …verbal and written summation of research to medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), ... + Perform ad hoc medical research for medical directors as needed for individual case reviews + Perform research regarding new CPT and HCPCS codes as required on… more
- University of Michigan (Ann Arbor, MI)
- …of care, administrative and outpatient denials. They manage and respond to Medicare , Medicare Advantage, Varis, Medicaid and other various commercial audits. ... knowledge of CMS regulations, OPPS coding for surgical procedures and the Medicare inpatient only list to ensure accurate reimbursement. + Review readmissions and… more
- Datavant (Lansing, MI)
- …work environment. + Keep up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide guidance and make strategic ... + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and...reviewed by Datavant Human Resources and determined on a case -by- case basis. Depending on the state in… more
- Molina Healthcare (MI)
- …RN Licensure._ _Case Manager RN will work in remote setting supporting our Medicare /Medicaid population who have recently been admitted into Hospital. The Case ... position and productivity is important. Preferred candidates will have previous case management, managed care, hospital, and/or home health experience._ _This role… more