- Bon Secours Mercy Health (Lorain, OH)
- …referrals to establish eligibility for care; understand and communicates Center for Medicare & Medicaid Services ( CMS ) medical necessity and admission criteria. ... The Admissions Coordinator RN cross trains to cover case management as needed, which includes initiating and directing the...on Accreditation of Rehabilitation Facilities (CARF), Joint Commission and CMS . Adheres to CMS , CARF and Joint… more
- Evolent (Columbus, OH)
- …from authoritative sources, including the American Medical Association (AMA), Centers for Medicare & Medicaid Services ( CMS ), Food and Drug Administration (FDA), ... seek to connect the pieces of fragmented health care system and ensure people get the same level of...culture. **What You'll Be Doing:** **Senior Scope Analyst, Scope Management ** The Specialty Scope Management team is… more
- Molina Healthcare (Akron, OH)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... including assisting and executing projects and tasks to ensure CMS and State regulatory requirements are met for pre-pay...At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept… more
- Humana (Columbus, OH)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Produces reporting and ... for quality improvement across all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid). Integrates diverse data sources to report… more
- Molina Healthcare (Dayton, OH)
- **Job Description** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members, providers, and pharmacies have access to all ... members, providers, pharmacists, pharmacies, and technicians to meet departmental and CMS standards. + Enforce HIPAA compliance standards and regulations while… more
- OhioHealth (Columbus, OH)
- **We are more than a health system . We are a belief system .** We believe wellness and sickness are both part of a lifelong partnership, and that everyone could ... financial reporting for clinical trials and research projects to provide system -wide support OhioHealth research activities. Activities include a variety of complex… more
- CVS Health (Columbus, OH)
- …vendor) to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes ... compliance with internal policies and procedures as well as regulatory guidance from CMS , OIG or other Regulatory body. **Required Qualifications** + Minimum of 1… more
- Intermountain Health (Columbus, OH)
- …alignment with ICD-10-CM and Official Coding Guidelines as determined by Centers for Medicare and Medicaid Services ( CMS ), National Center for Health Statistics ... Services (DHHS), American Hospital Association (AHA) and American Health Information Management Association (AHIMA). This position provides advanced training to CDI… more
- Molina Healthcare (OH)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare , or equivalent combination of relevant education and experience + Proven… more