- CenterWell (Corpus Christi, TX)
- …two to five years directly applicable experience preferred + Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... care environment in a value-based relationship environment + Knowledge of Medicare guidelines and coverage + Knowledge of HEDIS quality indicators **Additional… more
- Elevance Health (Denison, TX)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- Molina Healthcare (El Paso, TX)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality ... to identify opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may...skills. **PREFERRED QUALIFICATIONS:** + 1 year of experience in Medicare and in Medicaid managed care + Experience with… more
- CenterWell (Austin, TX)
- …delivery of associate-facing contact center technologies that support Pharmacy and Medicare Part D operations. This enterprise-wide platform empowers associates to ... a related field. **Preferred Qualifications:** + Understanding of pharmacy operations and Medicare Part D. + Experience with contact center platforms and CRM… more
- Humana (Austin, TX)
- …Provide quality of care reviews, as needed o Work with Specialty Quality Manager on annual quality work plan o Chair quarterly Specialty Quality Improvement ... in dental benefits industry issues preferred o Knowledge and experience in Medicare and Medicaid dental programs preferred **Additional Information** o The Dental… more
- Aveanna Healthcare (Laredo, TX)
- …Position Details Position: Clinical Supervisor (RN) $5,000 SIGN ON BONUS Clinical Case Manager Join a Company That Puts People First! Aveanna Healthcare is one of ... to infants, children, adolescents, and adults. Note: As an employer receiving Medicare and Medicaid funds, Aveanna employees must comply with all health-related… more
- Houston Methodist (Houston, TX)
- …FUNCTIONS** + Assists the department in distributing required notices, including the Medicare Notice of Discharge to patients, securing signatures on the form from ... and answering questions regarding the appeal process + Distributes the Medicare Notice of Discharges to identified patients, including capturing patient and… more
- Houston Methodist (Katy, TX)
- …Confers with Billers, as necessary, to obtain additional information/clarification. + Informs manager of payer trends or any problems or changes in payor ... Extensive knowledge of claims reimbursement and collection efforts for Managed Care, Medicare , Medicaid, Workers Comp, Commercial plans, etc.; knowledge of how to… more
- Apex Health Solutions (Houston, TX)
- …technicians) in all aspects of pharmacy operations and services including Medicare part D oversight, coverage determination and re-determination (appeal) process, ... it relates to CMS and other regulatory entities. Interacts with pharmacy benefit manager (PBM) to support the implementation of new pharmacy products or services and… more
- Evolent (Austin, TX)
- …to find the most valuable defects. The IQA reports to a associate director or a manager . One or many IQAs may be engaged in any testing effort **What You Will Be ... risks and issues in coordination with the lead / manager for status reporting + Responsible to enforce department...Good knowledge US Healthcare - Payer side, Knowledge of Medicare , Medicaid, Commercial Plans and understanding on claims workflow,… more