- Molina Healthcare (San Antonio, TX)
- …Opportunity for a Texas licensed RN to join Molina to work with our Medicare members in the San Antonio service delivery area; candidates should reside in Bexar ... will be given to those candidates with previous experience working with the Medicare population within a Managed Care Organization (MCO). Mileage is reimbursed as… more
- Apex Health Solutions (Houston, TX)
- …technicians) in all aspects of pharmacy operations and services including Medicare part D oversight, coverage determination and re-determination (appeal) process, ... and redetermination based on specific CMS required guidelines. Leads and support the creation, maintenance, and organization of SOP's, P&P, and business… more
- Molina Healthcare (Austin, TX)
- …Performs analysis across multiple states and lines of business ( Medicare , Medicaid, Marketplace ACA). **KNOWLEDGE/SKILLS/ABILITIES** + Compiling and organizing ... applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA...is easy to understand and provides insights needed to support strategic investment decisions + Research and develop reports… more
- Texas Health Resources (Stephenville, TX)
- …RRT - Registered Respiratory Therapist (requied) and + BCLS - Basic Cardiac Life Support required prior to independent patient care and + ACLS - Advanced Cardiac ... Life Support (preferred) and + NRP - Neonatal Resuscitation Program...of each treatment session in accordance with departmental, JCAHO, Medicare , and other applicable regulatory guidelines. + documents assessments… more
- Kelsey-Seybold Clinic (Spring, TX)
- …Nurse (APRN) Certifications: AANP, ANCC, or PNCB Must have Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) certifications _Kelsey-Seybold ... and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated with… more
- Kelsey-Seybold Clinic (Webster, TX)
- …+ Prepare and maintain accurate patient records, charts, and documents to support sound medical practice and reimbursement for services provided + Assist in ... development of clinical practice guidelines/standards in support of quality palliative care + Timely review, oversight, and documentation of patient care by team NP… more
- CVS Health (Austin, TX)
- …optimize client engagement and profitability by developing pricing offers that support client retention and growth. Daily activities include monitoring financial ... and maintaining a deep understanding of PBM financial levers within Commercial, Medicaid, Medicare Part D, and Public Exchange lines of business. + Conduct market… more
- CVS Health (Austin, TX)
- …medical costs and provides an unmatched experience for adults on Medicare in medically underserved communities. By providing holistic, comprehensive and integrated ... the industry-leading clinical operations and population health platform to support the delivery of high quality care to the... the delivery of high quality care to the Medicare population. As a Senior Product Manager within the… more
- Actalent (Texas City, TX)
- …determination. Responsibilities + Process and manage denied prior authorization requests for Medicare and Medicaid patients. + Make 30-60 outbound calls per shift to ... Medicare members, primarily elderly individuals, regarding denied medication requests....+ Review submitted documentation and gather additional information to support the appeals process. + Forward completed cases to… more
- Kelsey-Seybold Clinic (Webster, TX)
- …calls regarding admissions to the assigned hospital. + The hospitalists have the support from the critical care physicians and subspecialists. + There is no ... and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated with… more