- Molina Healthcare (Davenport, IA)
- **Job Description** **Job Summary** The Sr Specialist , Member & Community Interventions oversees and implements new and existing clinical quality member intervention ... initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality focused interventions and programs… more
- Molina Healthcare (Iowa City, IA)
- …in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). M-F from 8am - 4:30pm EST will require ... (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines… more
- Molina Healthcare (Iowa City, IA)
- …surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Specialist , Quality Interventions/ QI Compliance contributes to one or ... Health or Healthcare. **Preferred Experience** 1 year of experience in Medicare and in Medicaid. **Preferred License, Certification, Association** + Certified… more
- Molina Healthcare (Iowa City, IA)
- …to determine if providers have sanctions/exclusions. * Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of ... Medicare . * Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found. **JOB QUALIFICATIONS** **Required… more
- Molina Healthcare (Sioux City, IA)
- …tools such as Department of Health and Human Services (DSHS) and Medicare billing guidelines, Molina claims processing policies and procedures, and other resources ... to validate overpayments made to providers. * Completes basic validation prior to offset to include, eligibility, coordination of benefits (COB), standard of care (SOC) and diagnosis-related group (DRG) requests. * Enters and updates recovery applications and… more
- Molina Healthcare (Cedar Rapids, IA)
- …oral and written communication skills and presentation skills. + Medicare and Marketplace experience **JOB QUALIFICATIONS** **Required Education** High School ... regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare , Medicare Advantage, Medicare Part D, Medicaid,… more
- Molina Healthcare (Des Moines, IA)
- …highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** * Performs clinical/medical reviews of previously ... Procedure Coding (HCPC). * Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically… more
- Molina Healthcare (IA)
- …compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all ... is highly preferred. Work hours: Monday - Friday 8:00am - 4:00pm Remote position **Essential Job Duties** + Coordinates, conducts and documents pre-delegation and… more
- Evolent (Des Moines, IA)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... improvement, and clinical excellence. + **This position is 100% Remote and can be completed from any state. Multiple...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Molina Healthcare (Iowa City, IA)
- …(LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical ... or other health care or management certification. * Leadership experience. * Medicaid/ Medicare population experience. To all current Molina employees: If you are… more