- Prime Therapeutics (Atlanta, GA)
- …strategic plans that achieve Star Ratings and quality outcomes for Medicare , Medicaid, Individual Health Insurance Marketplace, and Commercial lines of business. ... the client quality support model strategy for all lines of business ( Medicare , Medicaid, commercial/HIM); serve as primary enterprise point of contact and subject… more
- Prime Therapeutics (Atlanta, GA)
- …experience in legal or compliance related roles for a healthcare or Pharmacy Benefit Management organization, or within a highly regulated industry, including ... experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +...related area of study, such as Juris Doctor + Medicare Part D, Medicaid, and/or Affordable Care Act knowledge… more
- CenterWell (Atlanta, GA)
- …quality and cost improvement for high-risk senior populations in full risk Medicare arrangements. This individual will help assess the value of each opportunity ... quality and value drivers in full risk care delivery, ideally in Medicare /seniors + Demonstrated ability to work collaboratively with clinical and operational… more
- Molina Healthcare (Savannah, GA)
- …Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate ... Performs analysis across multiple states and lines of business ( Medicare , Medicaid, Marketplace ACA). **KNOWLEDGE/SKILLS/ABILITIES** + Compiling and organizing… more
- CenterWell (Atlanta, GA)
- …3 or more years experience in a high-volume community or mail order pharmacy practice environment + Previous experience in utilization management + Education: BSN or ... a related field + Health Plan experience + Previous Medicare /Medicaid Experience a plus + Call center or triage...largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health… more
- STG International (Milledgeville, GA)
- …Coordinate Pre-certification sand recertification in accordance with facility policies for Medicare Advantage and + commercial insurance payers. + Interpret the ... disposal records for accuracy and notify the Director of Nursing and pharmacy of discrepancies. + Monitor medication administration process and provide appropriate… more
- CenterWell (Atlanta, GA)
- …services. Able to navigate healthcare options; care services post-acute offerings, Medicare coverage, billing issues, as well as accessing healthcare resources. + ... one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the… more
- Molina Healthcare (Savannah, GA)
- …or equivalent experience (such as specialties in: surgical, Ob/Gyn, home health, pharmacy , etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more
- CenterWell (Atlanta, GA)
- …improve quality and reduce costs for high-risk senior populations in full-risk Medicare arrangements. The Director will lead and oversee the strategic planning, ... one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the… more
- Cardinal Health (Atlanta, GA)
- …streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, ... concurrent assignments and work with a sense of urgency + Knowledge of Medicare , Medicaid and Commercially insured payer common practices and policies, preferred +… more