• Sr Specialist , Credentialing, Network…

    Cardinal Health (Austin, TX)
    …scheduled training. **_Qualifications_** + Bachelors degree or equivalent experience in Managed Care preferred + 2-4 years experience in health care preferred + ... Pharmacy Technician experience a plus, not required + Familiarity with Medicare and Medicaid + Proficient in Microsoft Office (Excel VLOOKUPS) + Strong written and… more
    Cardinal Health (07/24/25)
    - Related Jobs
  • Delaware Valley ACO Fellowship

    Humana (Austin, TX)
    …(DVACO) is an accountable care organization that participates in the Centers for Medicare and Medicaid Services' Medicare Shared Savings Program (MSSP), plus ... other commercial and Medicare Advantage value based programs. DVACO is a joint...Board + Leads strategic planning efforts to develop a specialist network within the ACO + Develops a health… more
    Humana (07/30/25)
    - Related Jobs
  • Bilingual Referral Coordinator

    ChenMed (Houston, TX)
    …5 days. + Orders have been approved (when needed). + Schedules patient ( Preferred Providers List of Specialist ) and notifies them of appointment information, ... with Web IVRs and obtaining referrals/authorizations for multiple payers strongly preferred + Healthcare experience within the Medicare Advantage population… more
    ChenMed (08/20/25)
    - Related Jobs
  • Senior Systems Engineer - IAM

    Ensono (Houston, TX)
    …US Citizenship and pass related background checks including but not limited to Medicare and Medicaid and VA ** Preferred Skills:** + Experience with secure ... policies, regulatory requirements, and industry best practices. The IAM Specialist will also be responsible for maintaining all necessary certifications… more
    Ensono (08/07/25)
    - Related Jobs
  • Senior Coding Data Quality Auditor, Regulatory…

    CVS Health (Austin, TX)
    …applicable) to ensure the ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are ... + CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist -Physician) required. + Experience with International Classification of Disease (ICD)… more
    CVS Health (08/21/25)
    - Related Jobs
  • Lead Analyst, Payment Integrity

    Molina Healthcare (San Antonio, TX)
    …and verbal communication skills including ability to synthesize complex information. ** PREFERRED QUALIFICATIONS:** + Experience with Medicare , Medicaid, and ... Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay… more
    Molina Healthcare (08/20/25)
    - Related Jobs
  • Payment Integrity Program Manager - Health Plan

    Molina Healthcare (Fort Worth, TX)
    …and verbal communication skills including ability to synthesize complex information. ** PREFERRED QUALIFICATIONS:** + Experience with Medicare , Medicaid, and ... achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for… more
    Molina Healthcare (08/14/25)
    - Related Jobs
  • Clinical Manager RN Sign On Bonus

    HCA Healthcare (San Antonio, TX)
    …Consumer Discounts + Retirement readiness, rollover assistance services and preferred banking partnerships + Education assistance (tuition, student loan, ... regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist ) to ensure the medical records reflect compliance with medical necessity,… more
    HCA Healthcare (06/21/25)
    - Related Jobs
  • Health Plan Operations, Payment Integrity Program…

    Molina Healthcare (Dallas, TX)
    …and verbal communication skills including ability to synthesize complex information. ** PREFERRED QUALIFICATIONS:** + Experience with Medicare , Medicaid, and ... and experience. + At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept to execution, especially… more
    Molina Healthcare (08/14/25)
    - Related Jobs
  • Field Medical Director, Interventional Cardiology…

    Evolent (Austin, TX)
    …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... (5) years' experience in the practice of Cardiology is preferred + Not under current exclusion or sanction by...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
    Evolent (07/30/25)
    - Related Jobs