- Molina Healthcare (Detroit, MI)
- …FWA referrals to regulatory agencies and law enforcement. + Documents appropriately all case related information in the case management system in an accurate ... manner, including storage of case documentation following SIU related requirements. Prepares detailed preliminary...+ Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of… more
- Humana (Lansing, MI)
- …by the location. + Reviews available information related to the member's case , including disciplines required, to determine assessment needs. + Monitor performance ... adherence to established care coordination benchmarks. + Identify members for specific case management and / or disease management activities. + Develop audit plans… more
- Humana (Lansing, MI)
- …assigned area in Wayne or Macomb county, to conduct in home visits with Medicare /Medicaid members.** The Field Care Manager Nurse 2 employs a variety of strategies, ... Field Care Manager will be responsible for managing a case load and completing assessments with members in their...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Datavant (Lansing, MI)
- …+ Proficient in ICD-10 coding. + Experienced in HCC coding across Medicare , commercial, and Medicaid sectors. + In-depth knowledge of medical terminology, ... requirements will be reviewed by Datavant Human Resources and determined on a case -by- case basis. Depending on the state in which you will be working, exemptions… more
- Humana (Lansing, MI)
- …with the Enterprise Operations Enablement (EOE) team our Insurance AI Lean Business Case for Correspondence Modernization + Development of a process to make use of ... to properly analyze and investigate requirements to determine other liable parties due to Medicare set aside settlement arrangements for both Part C and Part D +… more
- St. George Tanaq Corporation (Lansing, MI)
- …can be based anywhere in the United States. **Responsibilities** + Reviews medical records/ case file, writes a decision that is clear, concise, and impartial and ... **Required Experience and Skills** + One (1) year of Medicare appeals, medical review, clinical, healthcare regulatory interpretation/application, healthcare… more
- Evolent (Lansing, MI)
- …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
- Henry Ford Health System (Troy, MI)
- Responsible for assisting with all Salesforce initiatives for the Medicare Advantage line of business from the scoping phase through mapping and overall execution; ... develop requirements analysis, perform case reviews, and conduct fit/gap analyses by applying an...requirements; serve as operational business unit SME for the Medicare sales Operations and Retention team; attend daily stand-up… more
- Banner Health (MI)
- …knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment ... National Correct Coding Initiative (NCCI) and the effect on Case Mix Index by use of specialized software. 7....contacts. Must consistently demonstrate the ability to understand the Medicare Prospective Payment System, and the clinical coding data… more
- CenterWell (Lansing, MI)
- …Senior Primary Care's) highest need and complexity patients with care and case management services. The Director is response for the strategic direction, execution ... Transitions of Care Management (TCM) program, and Episodic Consult (single-use case specific offerings) programs designed to improve quality and reduce costs… more