- Highmark Health (Austin, TX)
- …:** **JOB SUMMARY** This job partners with business units to ensure compliance to rules, regulations, policies, and procedures of governmental, contractual, and/or ... trends, and/or contract changes. **ESSENTIAL RESPONSIBILITIES** + Manage and coordinate compliance related processes. + Monitor governance and compliance of… more
- Elara Caring (San Antonio, TX)
- …staffing levels at branch locations to meet patient needs. + Ensures compliance of current Medicare , Medicaid, and third-party reimbursement regulations and ... changes. Identifies and reports potential payment/coverage problems. + Supervises and coordinates utilization review activities. + Participates in strategic development of Key Accounts, including participation in weekly, monthly, and quarterly review meetings,… more
- Gentiva (San Marcos, TX)
- …+ Supervise all volunteer activity within the designated service area. + Maintain compliance with the Medicare Hospice Conditions of Participation 5% volunteer ... requirement. + Assess patient and family needs for volunteer services and coordinate appropriate placements. + Recruit, train, and retain Administrative, Direct Care, Vigil, and Bereavement volunteers. + Facilitate volunteer orientation and annual training… more
- Humana (Austin, TX)
- …and Health Insurance License required + Bilingual + Knowledge of the Medicare Advantage market, products, regulations, and compliance standards **Additional ... 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 (Austin, TX)
- …health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve ... data requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical...policy. All work occurs within a context of regulatory compliance and work is assisted by diverse resources, included… 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 ... the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All work occurs… more
- Humana (Austin, TX)
- …service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national ... internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to… more
- Humana (Austin, TX)
- …customers at the center of everything it does. Are you passionate about the Medicare population, looking for a role in management with the ability to directly impact ... self-driven individuals to join our team. Our Senior Manager, Medicare Sales, motivates and drives a team of ...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Austin, TX)
- …Ability to use data to drive business outcomes and decisions + Experience in Medicare /Medicaid, CMS (Centers for Medicare & Medicaid Services) or other Federally ... recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years....the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Austin, TX)
- …service should be authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which may include national clinical ... teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to… more