- CVS Health (MI)
- …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 are ... setting. + Sound knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity. + Identify clinically active… more
- Molina Healthcare (Grand Rapids, MI)
- …BH peer reviews and appeals * Supports BH committees for quality compliance . * Implements clinical practice guidelines and medical necessity review criteria * ... Tracks all clinical programs for BH quality compliance with NCQA and CMS * Assists with the...(TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development,… more
- Humana (Lansing, MI)
- …into new processes; flexibility in job focus + Understanding of Centers for Medicare & Medicaid Services (CMS) guidelines Travel: While this is a remote position, ... to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Lansing, MI)
- …years working in Occupational Therapy. + Experience working with Medicaid and/or Medicare Plans. + Experience working with vulnerable populations and the assessment ... to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Lansing, MI)
- …into new processes; flexibility in job focus + Understanding of Centers for Medicare & Medicaid Services (CMS) guidelines Travel: While this is a remote position, ... to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Lansing, MI)
- …any issues or explain sales payment details. They work directly with Medicare carriers to understand carrier commission statements, answer questions, perform audits, ... to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- CenterWell (Lansing, MI)
- …Experience working in coding languages such as SAS and SQL + Prior Medicare Advantage or health insurance background + Additional skills developing reports and ... role provides a unique opportunity to get hands on Medicare Advantage experience in a rapidly growing area outside...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Detroit, 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, ... to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- CenterWell (Lansing, MI)
- …innovation for chronically and temporarily homebound, polychronic, and high-risk Medicare patients within a full-risk, value-based framework. The Medical Director ... with clinicians, executives, and operational leaders. + Advanced knowledge of Medicare regulations, value-based care principles, and best practices for complex care… more
- Humana (Detroit, MI)
- …assigned area in Wayne or Macomb county, to conduct in home visits with Medicare /Medicaid members.** **Must reside in Michigan with the ability to drive to Wayne or ... to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more