• Non-Clinical Coding and OASIS Review Manager

    BAYADA Home Health Care (Austin, TX)
    …for quality and adherence to policies and procedures. As a member of the Medicare Case Management (MCM) office, individuals in this role are expected to ... Manager provides support to all BAYADA Home Health Care Medicare service offices by monitoring Outcome and Assessment Information...the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines. + Review… more
    BAYADA Home Health Care (08/15/25)
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  • MDS Coordinator (RN or LVN)

    STG International (Temple, TX)
    …a period not to exceed thirty days. Familiar with Reimbursement system of Medicare , Medicaid & Case Management Preferred Skilled Nursing Facility Experience as ... an MDS Nurse CMAC certification or completion within 30 days of hire and renewal every 2 years MDS coordinator must maintain current with the training (renewal every 2 years). Knowledge of state and federal regulations, both clinical and financial as it… more
    STG International (07/31/25)
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  • Behavioral Health Medical Director…

    Humana (Austin, TX)
    …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
    Humana (08/09/25)
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  • RN Medicare Compliance Sr

    Sedgwick (Austin, TX)
    …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
    Sedgwick (08/29/25)
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  • Director, Operational Oversight ( Medicare

    Molina Healthcare (Fort Worth, TX)
    …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 (07/13/25)
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  • Senior Medical Director ( Medicare )

    Molina Healthcare (San Antonio, TX)
    …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
    Molina Healthcare (06/13/25)
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  • Worklife Resource Consultant - Medicare

    CVS Health (Austin, TX)
    …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
    CVS Health (06/28/25)
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  • Program Director - Medicare Duals (Remote)

    Molina Healthcare (San Antonio, TX)
    …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
    Molina Healthcare (08/22/25)
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  • Case Management Assistant

    HCA Healthcare (Austin, TX)
    …Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) Case Management Assistant with St. David's Medical Center you can be a ... in our organization. We are looking for an enthusiastic Case Management Assistant to help us reach our goals....including having the Patient Choice letter signed. + Monitors Medicare patient's planned discharge dates and delivers the Important… more
    HCA Healthcare (08/31/25)
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  • Registered Nurse (RN) - Case Manager - PRN

    Texas Health Resources (Arlington, TX)
    Registered Nurse (RN) - Case Manager - PRN Work location: Texas Health Arlington 800 W. Randol Mill Road TX 76012 Work hours: PRN - Weekend/Evening Shift Department ... staff. Applies nursing/clinical knowledge skills and problem solving techniques to the case management process. 5. Meets directly with patient and family members… more
    Texas Health Resources (08/29/25)
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