- Cardinal Health (Austin, TX)
- …about long and short-range changes in the reimbursement environment including Medicare , Medicaid, Managed Care, and Commercial medical and pharmacy plans while ... experience preferred + High School diploma or equivalent preferred + Knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers policies and guidelines for… more
- Molina Healthcare (Austin, TX)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality ... excellent problem-solving skills. **PREFERRED QUALIFICATIONS:** + 1 year of experience in Medicare and in Medicaid managed care + Experience with data reporting,… more
- Prime Therapeutics (Austin, TX)
- …in Excel, Word, and system operations (eg workflow processes and case management) + Government programs ( Medicare ) knowledge **Preferred Qualifications** ... all lines of business to support the Centers for Medicare & Medicaid Services (CMS) Star and HEDIS quality...meets the specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid… more
- Humana (Austin, TX)
- …teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to ... 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… more
- Humana (Austin, TX)
- …help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will...NCD/LCD, MCG(R) or InterQual** **The Medical Director conducts clinical case reviews of requests received by members of the… more
- Molina Healthcare (Austin, TX)
- …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 (Austin, TX)
- …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 (TX)
- …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 (TX)
- …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
- Humana (Austin, TX)
- …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