- Molina Healthcare (OH)
- …for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other Core Ops areas of responsibilities) within ... Medicare and Medicaid. Role is predicated on building relationships...needs and satisfaction, financial budgets, and current and future program initiatives. Ability to drive operational excellence and process-oriented… more
- Molina Healthcare (Cleveland, OH)
- … Duals, Appeals & Grievances, Provider Disputes (Par and Non-Par) and overall Medicare program knowledge. * Experience reviewing all types of medical claims ... claims review and/or member appeals and grievance processing/resolution, including 3 years in a manager role. * Experience with Medicare Regulations, Medicare… more
- Molina Healthcare (Columbus, OH)
- …be licensed for the state of OHIO. This position will support our MMP (Medicaid Medicare Population) with members on Waiver program . This position will have a ... case load and manage members enrolled in this program . We are looking for Registered Nurses who have...of members per regulated timelines. + Facilitates comprehensive waiver enrollment and disenrollment processes. + Develops and implements a… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Under limited supervision, ... such as phone, email, and video conferencing. Verifies eligibility, benefits, enrollment history, clinical history, and demographics. Assesses patient needs by… more
- Trinity Health (Westerville, OH)
- …Full time **Shift:** Day Shift **Description:** RN Case Manager , Full-time **Why Mount Carmel?** With five hospitals ... (https://www.mcmg.mountcarmelhealth.com/) , a college of nursing (https://www.mccn.edu) , a Medicare Advantage plan (https://www.medigold.com) , and extensive outreach and… more
- Trinity Health (Reynoldsburg, OH)
- **Employment Type:** Full time **Shift:** **Description:** **Position Purpose:** The Practice Manager oversees the day-to-day operations in two or more practice ... of 3 years of experience as a medical practice manager in a high volume physician practice. + 3...communication systems. + Knowledge of healthcare insurance industry including Medicare , Medicaid Managed Care and other governmental and commercial… more
- CVS Health (Columbus, OH)
- …all with heart, each and every day. **Position Summary** As the Lead Director, DSNP Program Management you will support the General Manager in all aspects of the ... to specifications and within budgeted costs. + Apply advanced knowledge of the Medicare and Medicaid regulatory landscape to ensure program compliance with… more
- Somatus (Cincinnati, OH)
- …telephonic outreach to members within designated geographic area to introduce the Somatus program and encourage enrollment to build their patient caseload. + ... care team, specifically under the guidance of RN Care Manager and act as an advocate guiding them through...assessment to help align patients with the most appropriate program inaccordance with program guidelines. + Documents… more
- Trinity Health (Columbus, OH)
- …, a college of nursing (https://www.mccn.edu/) , a Medicare Advantage plan (https://www.medigold.com/) , and extensive outreach and ... Generous paid time off programs + Employee recognition incentive program + Tuition/professional development reimbursement + Relocation assistance (geographic… more
- Trinity Health (Columbus, OH)
- …, a college of nursing (https://www.mccn.edu/) , a Medicare Advantage plan (https://www.medigold.com/) , and extensive outreach and ... Generous paid time off programs + Employee recognition incentive program + Tuition/professional development reimbursement + Relocation assistance (geographic… more
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