- NTT America, Inc. (Plano, TX)
- …Manager to join our team. NTT DATA is seeking to hire a ** Medicare Appeals Clinical Leader** to lead service delivery engagements and improve end-to-end delivery ... of Medicare Appeals. Desire experience specifically for processes for clinical...performance, metrics, and processes. + Track appeal metrics, including case volumes, resolution times, and denial rates. + Analyze… more
- Datavant (Austin, TX)
- …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
- Insight Global (Houston, TX)
- …Epic Clinical Application Analyst with a focus on Inpatient ClinDoc and Clinical Case Management to join our dynamic care coordination team. This role is essential ... The ideal candidate will be certified in both Inpatient ClinDoc and Clinical Case Management, with a preference for those holding the latter. Key Responsibilities:… more
- HCA Healthcare (Austin, TX)
- …psychosocial and environmental needs as evidenced by documentation, clinical records, case conferences, team reports, call-in logs and on-site evaluations. + ... public nursing or acute hospital nursing experience + Familiar with Medicare home health regulations, documentation requirements, ICD-10 coding and PPS (Strongly… more
- HCA Healthcare (San Antonio, TX)
- …competencies and performance of assigned home health care team(s)Supervises ongoing case management of all patients ensuring an accurate evaluation and treatment ... you will need:** Two years of experience within a licensed and certified ( Medicare ) home health agency requiredCompetent in Federal ( Medicare ) and Local… more
- Healthfirst (TX)
- …**8am-5pm or** **8:30am-5:30pm** **Duties and Responsibilities:** + Responsible for case development and resolution of clinical cases, such as: Pre-existing ... Update file documentation such as the file notes and case summary + Manage all duties within regulatory timeframes...(NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently… more
- Molina Healthcare (TX)
- …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
- CenterWell (Eastland, TX)
- …the delivery of care to all patients served by the location. Receives case referrals. Reviews available patient information related to the case , including ... the decision to admit patients to service. Assigns appropriate clinicians to a case , as needed. + Instructs and guides clinicians to promote more effective… more
- Molina Healthcare (Houston, TX)
- …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
- CommonSpirit Health (Houston, TX)
- …of Texas. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews referred by case management staff and/or other health care ... efficient utilization of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations… more