- Elevance Health (Columbus, OH)
- …regulatory and contract requirements. + Oversee care coordination and provider incident reporting to include conducting reporting, triaging, investigating, ... effective care through assessing the medical necessity of inpatient admissions, outpatient services , out of network services , and appropriateness of treatment… more
- Centene Corporation (Latham, NY)
- …The Health Benefit Representative (HBR) sells Fidelis Care products and services by first identifying membership growth opportunities in an assigned territory ... offered through the New York State of Health (NYSOH), Medicaid Managed Care, Child Health Plus, Medicare, MLTC, FIDA...benefit questions; compare and contrast Fidelis Care products and provider network of competing plans in assigned territory. +… more
- Johns Hopkins University (Baltimore, MD)
- …audit teams to ensure effective utilization in completing assigned projects. + Provide day-to-day support for assigned staff, eg create open lines of communication, ... provide regulatory updates, advise on difficult situations, etc. +...Executive Director Operational Audits, and Chief Audit Officer. + Lead and/or direct work of audit staff regarding review… more
- Fallon Health (Worcester, MA)
- …improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and ... challenges + Attends IDT meetings keeping track of initial services ; and any changes to service needs...elderly population + At least one year in a lead or supervisory capacity + Must complete a standardized… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Director participates in the broad array of activities of the Medical Services area including, but not limited to, Medical and Pharmacy Utilization Management, ... of policies, programs and strategic objectives that cover Medical Management Services through their required participation in various committees and when assigned… more
- Select Medical (Springfield, MO)
- …as hemodialysis technician required + CCHT required + Center for Medicaid /Medicare Services (CMS) approved state and/or national certification required ... critical illness recovery hospital committed to providing world-class inpatient post-ICU services to chronic, critically ill patients who require extended healing… more
- Centene Corporation (Atlanta, GA)
- …on workplace flexibility. **Position Purpose:** Recruit physician, hospital and ancillary service providers to sign network participation agreements that are in ... network for a region and set of providers + Lead assigned recruitments (ie, physician, hospital and ancillary) and...that meet objectives + Facilitate and oversee to the provider set-up and contract configuration to ensure accurate claims… more
- Help at Home (Miami, FL)
- …Company_** _, proudly serves communities across Florida as part of the nation's leading provider of in-home personal care services . Our mission is to empower ... caregivers and clients who rely on us. If you lead with passion and integrity and are eager to...manage multiple responsibilities. + Able to supervise staff and provide necessary feedback to improve overall services .… more
- Providence (Santa Monica, CA)
- …a 5-star rating for quality, safe care from the Centers of Medicare and Medicaid Services (CMS). Under the direction of the Department Director, the day-to-day ... supervision of the Lead Technologist and/or Manager and in close collaboration with...department standards utilizing age-specific criteria. Serves as a customer service representative to patients, their families, the public, and… more
- State of Massachusetts (Worcester, MA)
- …to promote health, prevent disease, and address barriers to accessing healthcare needs and services of youth in care or custody. They will serve as a member of ... the DCF Health and Medical Services Team (HMST) and will be instrumental in supporting...if the prior authorization request has been submitted. * Provide appropriate referrals to community-based healthcare providers; Assist staff… more