- MyFlorida (Tallahassee, FL)
- …and planning entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities, ... work with multiple units within the bureau. The Florida Medicaid program is one of the five largest in...an estimated $38 billion annual budget. Each month Florida Medicaid covers medical services for almost 5.5 million recipients.… more
- State of Indiana (Indianapolis, IN)
- …across Indiana. About the Family & Social Services Administration: The Office of Medicaid Policy and Planning (OMPP) is a division within the Family and Social ... the Director of Quality Improvement (QI), an integral component in serving Medicaid members. This clinical leader will develop, design, implement, and manage… more
- State of Georgia (Cobb, GA)
- …Perinatal Case Management (PCM), Babies Born Healthy (BBH), PE Pregnant Woman Medicaid (PEMD). Responsibilities include, but not limited to: screen clients for ... services of prenatal clients. Lead worker in processing PE Pregnancy Medicaid applications. Assists with troubleshooting Medicaid problems, training staff,… more
- New York State Civil Service (Brooklyn, NY)
- …as an excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal or Federally ... for your services to be billed through Medicare and Medicaid . If you are appointed and are required to...and lose the ability to bill through Medicare and Medicaid , you may be terminated from your employment. Minimum… more
- Iowa Department of Administrative Services (Des Moines, IA)
- …Type Full-time Job Number 26-01447 Agency 400 Health & Human Services - Medicaid Opening Date 12/02/2025 Closing Date 12/14/2025 11:59 PM Central LinkedIn Tag ... list. The Iowa Department of Health and Human Services (HHS), Division of Medicaid , Bureau of Quality Innovation and Medical Policy is seeking aMedicaid Pediatric… more
- Integra Partners (Troy, MI)
- …ensures determinations are made in accordance with Medicare and Medicaid guidelines, health plan-specific criteria, internal policies, and regulatory requirements. ... reviews of DMEPOS authorization requests using applicable criteria, including LCDs, Medicaid Manuals, InterQual, MCG, internal medical policies, and health plan… more
- CVS Health (Columbus, OH)
- …actionable insights to support fraud, waste, and abuse (FWA) detection and Medicaid regulatory & compliance reporting. This is an individual contributor role. Job ... data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate Medicaid … more
- University of Rochester (Rochester, NY)
- …access for patients. Remains knowledgeable of private payer, Medicare, and Medicaid structure systems and reimbursement processes. Respond to all patient, nursing, ... well as University of Rochester groups, with Medicare and Medicaid as required each cycle. + Completes new enrollments...and tracks the status of provider enrollment applications for Medicaid , Medicare, and some Commercial Payers that are not… more
- CVS Health (Downers Grove, IL)
- …communication skills to support, manage and develop and execute Medicare and Medicaid compliance programs and processes that promote compliant and ethical behavior, ... Program as described in CMS Medicare Managed Care Manuals/regulations, applicable Medicaid rules and government contracts, including risk assessment, auditing and… more
- City of New York (New York, NY)
- …HRA operations. Within OAS, County Demo Unit performs audits to assess the Medicaid Provider's compliance with laws, rules, regulations, and policies of the ... Medicaid program as set forth by the Departments of...who will: - Conduct audits for goods /services of Medicaid Providers. Utilize standard audit procedures examine records and… more