- Houston Methodist (Houston, TX)
- …competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees, ... discharge planning, progression of care, documentation of improvement, and Medicare Conditions of Participation. **QUALITY/SAFETY ESSENTIAL FUNCTIONS** + Ensures a… more
- Fresenius Medical Center (Fort Worth, TX)
- …the designated clinical application in an accurate and timely manner. + Review treatment sheets for completeness, ensure nursing signatures are documented, and ... or state specific certification as defined by Center for Medicaid/ Medicare (CMS)Allappropriatestatelicensure,education,andtraining(ifany) required. + Demonstrated commitment to organization culture,… more
- Fresenius Medical Center (Harker Heights, TX)
- …the designated clinical application in an accurate and timely manner. + Review treatment sheets for completeness, ensure nursing signatures are documented, and ... or state specific certification as defined by Center for Medicaid/ Medicare Services (CMS)Allappropriatestatelicensure,education,andtraining(ifany) required. + Demonstrated commitment to organization… more
- STG International (Temple, TX)
- …and care needs. Follow and educate community team members on the review process and provide recommendations to address potential areas of concern/opportunity, ... X2 to obtain a 6 day look back and review for anything that flags impacting care plans and...to exceed thirty days. Familiar with Reimbursement system of Medicare , Medicaid & Case Management Preferred Skilled Nursing Facility… more
- Molina Healthcare (San Antonio, TX)
- …care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU ... also entails producing audit reports for internal and external review . The position may also work with other internal...+ Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of… more
- Prime Therapeutics (Austin, TX)
- …signoff of deliverables by all impacted parties + Facilitate solution design review discussions between IT resources and business requestors to resolve questions ... requested software changes, and participate with Quality Assurance and UAT resources to review related test cases and/or scenarios + Serve as subject matter expert… more
- Datavant (Austin, TX)
- …outcomes, measure product impact, and support value-based client delivery across Medicare Advantage, ACA, and Medicaid programs. The ideal candidate combines deep ... protected status. To learn more about our commitment, please review our EEO Commitment Statement here (https://www.datavant.com/eeo-commitment-statement) . Know Your… more
- HCA Healthcare (Corpus Christi, TX)
- …leadership + Work with team members in billing, revenue integrity and/or the Medicare Service Center to resolve alerts/edits + Assign interim DRGs for in-house ... lead, manager, international log) + Periodically works with manager to review individual work accomplishments, discuss work problems/barriers, discuss progress in… more
- Insight Global (Fort Worth, TX)
- …for pensions, annuities, investments and other sources - Social Security and Medicare Planning - Military and Federal Employee Benefits- Retirement planning and ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills… more
- CenterWell (Austin, TX)
- …call related include but are not limited to: + **Pharmacist Care Plan/Treatment Review ** + Review prescriptions for accuracy + Check for drug-drug interactions ... + Previous experience with pharmacy benefits management + Previous Commercial, Medicare and/or Medicaid experience + Previous clinical experience in managed care… more