- Molina Healthcare (Augusta, GA)
- …sample universes, and submission of SOPs, training materials, and/or other evidence as part of regulatory audits. EX: DMHC, CMS active audits. Responsible for acting ... or special projects as required. + Must have experience working in Medicare + Must have experience analyzing claims. **Job Qualifications** **REQUIRED EDUCATION:**… more
- CenterWell (Savannah, GA)
- …trends and areas of opportunity in pharmacy utilization (pharmacy management) to impact Part D per Member per Month (PMPM) costs while maintaining high ... **Become a part of our caring community and help us...**Preferred Qualifications** + Active and unrestricted DEA license + Medicare Provider Number + Medicaid Provider Number + Minimum… more
- CenterWell (Marietta, GA)
- **Become a part of our caring community and help us put health first** Humana's Primary Care Organization is one of the largest and fastest growing value-based care, ... care team consists of doctors, advanced practice professionals, Pharm D , Care Coach Nurse, MA, Behavioral health specialist, Quality...This role is considered patient facing and is a part of our Tuberculosis (TB) screening program. If selected… more
- CenterWell (Decatur, GA)
- **Become a part of our caring community and help us put health first** Humana's Primary Care Organization is one of the largest and fastest growing value-based care, ... Our care team consists of Doctors, Advanced Practice professionals, Pharm D , Care Coach Nurses, Medical Assistants, Behavioral Health, Specialists, Quality Based… more
- CenterWell (Scottdale, GA)
- **Become a part of our caring community and help us put health first** The Primary Care Physician (PCP) works as a lead in our team-based care environment. We are a ... serve. Our care team consists of doctors, advanced practice professionals, Pharm D , care coach nurses, MAs, behavioral health specialists, quality based coders,… more
- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** Become a part of our caring community and help us put health first The Encounter Data ... PowerPoint) + Working knowledge of SQL + Familiarity with EDI X12 formats (837P/I/ D , 999, 277, 835, 270/271, 834) + Demonstrated ability to identify process gaps… more
- Humana (Atlanta, GA)
- …or other pharmacy related field + Experience in Formulary strategy/development and CMS Part D guidance + Experience in analysis and problem-solving + Excellent ... **Become a part of our caring community and help us...methods to develop and influence formulary strategies for Humana's Medicare line of business. + Utilizes broad understanding of… more
- Molina Healthcare (GA)
- …Opportunity for a Texas licensed RN to join Molina to work with our Medicare members in the San Antonio service delivery area; candidates should reside in Bexar ... County. Part of the responsibilities of the role is to...to those candidates with previous experience working with the Medicare population within a Managed Care Organization (MCO). Mileage… more
- Aveanna Healthcare (Rincon, GA)
- …Aide training and competency evaluation program pursuant to the requirements of 42 CFR part 483, Subpart D ; or Health Care or Personal Care credentialing program ... change at any time with or without notice. As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all… more
- Prime Therapeutics (Atlanta, GA)
- …PBM industry, Medicaid, Medicare , and health plans + Pharmacist / Pharm D + Experience with contract language and risk mitigation concepts Every employee must ... are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at ### or email… more