- CenterWell (Norfolk, VA)
- …indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals + Personally ... primary care including health promotion & prevention, disease management, effective specialist & hospital co-management, and complex care management + Spend 20-30%… more
- Humana (Detroit, MI)
- …assigned area in Wayne or Macomb county, to conduct in home visits with Medicare /Medicaid members.** The Field Care Manager Nurse 2 employs a variety of strategies, ... **Required Qualifications** + **Registered Nurse, Nurse Practitioner, or Clinical Nurse Specialist with** **a minimum of 1** **year in-home experience** : care… more
- Texas Health Resources (Arlington, TX)
- …providers to ensure continuity of care plan. Assists in obtaining PCP or specialist physician follow-up. 8. Obtain follow-up PCP appointment prior to discharge when ... the effectiveness of performance improvement activities in order to achieve compliance with external agencies. 3. Collaborates with multi-disciplinary teams to… more
- CenterWell (Jacksonville, FL)
- …indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals + Personally ... primary care including health promotion & prevention, disease management, effective specialist & hospital co-management, and complex care management + Spend 20-30%… more
- Polaris Pharmacy Services, LLC (Fort Lauderdale, FL)
- …Remote Position Type Full Time Job Category Pharmaceutical Description PRIOR AUTHORIZATION SPECIALIST (REMOTE) WHO WE ARE Polaris Pharmacy Services is an industry ... Authorization Technicians to join the Polaris team. OVERVIEW The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected… more
- Polaris Pharmacy Services, LLC (Covina, CA)
- …to all our team members. JOB SUMMARY: The Lead Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected pharmacy ... financial risks to Polaris and their customers. The Lead Prior Authorization Specialist must be responsive and courteous when addressing our customers' needs.… more
- UnityPoint Health (West Des Moines, IA)
- …department compliance requirements for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or ... concerns regarding compliance to the immediate attention of hospital administrative staff....able to pass a competency. - Registered Cardiovascular Invasive Specialist (RCIS) - Registered Cardiovascular Electrophysiology Specialist … more
- Highmark Health (Pittsburgh, PA)
- …with all applicable guidelines, regulations and laws established by the Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services ... documentation accuracy and completeness. Creates a culture focused on Compliance and Core Behaviors. Builds strong partnerships with Highmark cross-functional… more
- Sanford Health (SD)
- …medical documentation, assign appropriate codes (ICD-10, HCPCS, CPT), and ensure compliance with coding standards, regulations, and company procedures. The position ... relative value units as appropriate for the role. Understands and supports the Medicare and Commercial Carrier workflows related to daily coding and denial review… more
- Banner Health (KY)
- …assurance for medical records. For all assigned records and/or areas assures compliance with coding rules and regulations according to regulatory agencies for state ... Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG)...make needed corrections and ensure accurate coding, reimbursement, and compliance . 7. Provides mentoring for less experienced staff members… more