- Humana (Trenton, NJ)
- …help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work ... group practice management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or… more
- Humana (Trenton, NJ)
- …group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how… more
- RWJBarnabas Health (Oceanport, NJ)
- Inpatient Coding Quality Officer III - ( Medicare ) RemoteReq #:0000183242 Category:Coder Status:Full-Time Shift:Day Facility:RWJBarnabas Health Corporate Services ... 07757 Job Title: Inpatient Coding Quality Officer III - ( Medicare ) Location: Barnabas Health Corp Department: HIM - Coding...a team with other Quality Officers to ensure SMART review goals are met for all RWJBarnabas facilities. +… more
- CVS Health (Trenton, NJ)
- …talent! We have an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist. The position will be a part of a specialized team ... who will focus on educating existing Medicare members on available plan offerings to help meet...in internal monitoring audits and coaching feedback sessions to review schedule adherence, quality, selling skills and compliance. +… more
- Sedgwick (Trenton, NJ)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Medicare Compliance Sr **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, ... specialized document review , and analysis and interpretation of interventions for the...analysis and interpretation of interventions for the preparation of Medicare Set-Aside allocations. **ARE YOU AN IDEAL CANDIDATE?** We… more
- Humana (Trenton, NJ)
- …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about… more
- Humana (Trenton, NJ)
- …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
- Specialty Rx, Inc. (Ridgefield Park, NJ)
- Job Description SpecialtyRx is a full-service pharmacy. We need Medicare Part B- Billing Representative with Pharmacy experience in our Ridgefield Park, NJ location. ... and benefits package. Responsibilities: + Experience with billing Part B claims, review and handle denials. + Knowledge with vaccine billing, including Covid. +… more
- Humana (Trenton, NJ)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will...daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
- Humana (Trenton, NJ)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more