- Virtua Health (Pennsauken, NJ)
- …resource group and payers.Documentation* Appropriate and complete documentation of clinical review and denial management in the case management documentation system ... or 3 years experience as Clinical Social Worker.Basic understanding of Medicare , Medicaid and managed care.Discharge planning or home health background.Excellent… more
- RWJBarnabas Health (Oceanport, NJ)
- …will serve as a key resource to department leadership for providing Medicare and Medicaid reimbursement support and implementing government payment strategies across ... Health hospitals. This includes planning, preparing and reviewing of the annual Medicare /Medicaid cost reports filings. In partnership with the Vice President of… more
- Humana (Trenton, NJ)
- …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 ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All work occurs with a… more
- Humana (Trenton, NJ)
- …and other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the ... and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization. **Additional… more
- Prime Therapeutics (Trenton, NJ)
- …and making outbound calls to qualified members across all lines of business to review the benefits of the MTM program. This position speaks with members to gather ... meets the specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid...$17.85 - $25.48 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our… more
- Atlantic Health System (Morristown, NJ)
- Under the supervision of the Assistant General Counsel (ACG), review prepare and negotiate a full range of hospital contracts including, without limitation, ... issues, including fraud and abuse issues, HIPAA compliance, EMTALA, Medicare and Medicaid compliance, licensure issues, pay-to-play issues, corporate governance… more
- Nestle (Bridgewater, NJ)
- …providers. This role focuses on creating value-based nutrition solutions for the Medicare Advantage population, offering a unique opportunity to shape a new position ... to drive growth and expand access to medical nutrition especially in the Medicare Advantage space + Gain alignment among internal stakeholders on customer specific… more
- Prime Therapeutics (Trenton, NJ)
- …related partner/customer relationships including pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid. The Sr Director, Pharm ... + Direct the oversight of Trade formulary strategies for Commercial, Exchange, Medicare Part D and/or Medicaid template formularies, including items such as… more
- Prime Therapeutics (Trenton, NJ)
- …Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid) + Other duties as assigned **Education & Experience** + ... Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more
- Evolent (Trenton, NJ)
- …provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more