- Centene Corporation (Austin, TX)
- …per year Centene offers a comprehensive benefits package including: competitive pay, health insurance , 401K and stock purchase plans, tuition reimbursement, paid ... for our 28 million members. Centene is transforming the health of our communities, one person at a time....with D-SNP SMAC, regulatory requirements and/or operations required + Medicare managed health experience required Pay Range:… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Associate Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and ... to an organization focused on continuously improving consumer experiences + 3+ years health industry experience with ASA, or 1+ years health industry experience… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Senior RX Clinical Programs Pharmacist integrates programs developed to improve overall ... health outcomes with a focus on prescription drugs. The...Previous experience with pharmacy benefits management + Previous Commercial, Medicare and/or Medicaid experience + 3 or more years… more
- Cognizant (Austin, TX)
- …Necessity Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines. . Review ... denial management and managing clinical denials from Providers to the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing… more
- CenterWell (Austin, TX)
- **Become a part of our caring community and help us put health first** The Care Delivery Call Quality Professional works within the PCO Growth and Retention group. ... and monitoring the Tele Sales Agents who are responsible for converting Medicare eligible callers to patients. The Care Delivery Call Quality Professional is… more
- Abbott (Plano, TX)
- …of education and work experience + General knowledge of private insurance , Worker's Compensation and Medicare guidelinespertaining toProspective and ... similar work experience. **Preferred** **Qualifications** + Knowledge of private insurance , Worker's Compensation and Medicare guidelinespertaining toProspective… more
- Abbott (Plano, TX)
- …combination of education and work experience + General knowledge of private insurance , Worker's Compensation and Medicare guidelines pertaining to Prospective ... or similar work experience. **Preferred** **Qualifications** + Knowledge of private insurance , Worker's Compensation and Medicare guidelines pertaining to… more
- HCA Healthcare (San Antonio, TX)
- …**Benefits** Methodist Hospital offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and ... cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... BSN or Bachelor's degree in a related field + Health Plan experience + Experience in utilization management or...criteria to ensure appropriateness of care preferred + Previous Medicare experience a plus + Milliman MCG experience preferred… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Associate Director, HEDIS Operations of Non-Standard Supplemental for business operations ... of, numerous strategies required to ensure success for our Medicare Stars and Medicaid LOBs. The ideal candidate for...data to identify trends and opportunities for improved member health and measure compliance + Internal and external partnerships… more