• Utilization Management Manager (Hybrid)

    CareFirst (Baltimore, MD)
    …and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** MD Medicaid / DSNP Clinical ... FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages policies and… more
    CareFirst (07/12/25)
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  • Case Management Specialist

    CVS Health (Harrisburg, PA)
    … Knowledge:** Experience or willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. + **Community Resources:** ... the requirements of the position **Preferred Qualifications** + Experience providing care management for Medicare and/or Medicaid members + Experience working… more
    CVS Health (09/18/25)
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  • Case Management Analyst- Field

    CVS Health (Annapolis, MD)
    …routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members. ... Helps implement projects, programs, and processes for Case Management . Applies practical knowledge of Case Management to administer best of class policies,… more
    CVS Health (09/04/25)
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  • Financial Specialist Assistant

    NHS Management, LLC (Athens, AL)
    …assigned business and financial functions within the parameters established by NHS Management , LLC guidelines, state and federal regulations, and as needed to ... office related tasks, including but not limited to: + Medicaid , Medicare and/or secondary billing + Assist with evaluation...timely submission to prevent delays in the attainment of eligibility and payment. Process to include: + Meeting with… more
    NHS Management, LLC (09/09/25)
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  • Business Analyst - MED

    Idaho Division of Human Resources (ID)
    …TO BE CONSIDERED.* Do you want to improve health outcomes and ensure all Medicaid members have access to quality care? The Bureau of Population Health in the ... Division of Medicaid is seeking aBusiness Analystto facilitate internal and external...health and quality improvement initiatives, some experience with project management , problem solving and building consensus among diverse stakeholders,… more
    Idaho Division of Human Resources (09/09/25)
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  • Staff Utilization Management Pharmacist…

    CenterWell (Austin, TX)
    …+ Eligibility to participate in federal prescription programs (eg, Medicare/ Medicaid ) + Self-directed with the ability to work effectively both independently and ... caring community and help us put health first** The Staff Utilization Management Pharmacist (VSP/PT) is a clinical expert responsible for conducting medical… more
    CenterWell (09/11/25)
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  • Senior Resident Account Specialst

    St. John's Embrace Living (Rochester, NY)
    …Billing Specialist position reports directly to the Director of Revenue Cycle Management and will assist in the resident billing and revenue collection function ... patient health care information, billing, and revenue collections + New York State Medicaid and Medicare rules and regulations + Basic methods and procedures of… more
    St. John's Embrace Living (08/29/25)
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  • Recovery - Coordinator 1

    Louisiana Department of State Civil Service (Baton Rouge, LA)
    …support in responses to escalated matters. + Develops an advanced working knowledge of Medicaid and Eligibility policy to interpret Medicaid claims. + ... amounts and processes incoming payments. + Provides support to the Medicaid Fraud and Recovery Investigative Unit's ongoing, statewide operational activities… more
    Louisiana Department of State Civil Service (07/19/25)
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  • Unit Supervisor

    City of New York (New York, NY)
    …PERMANENT IN THE PRINICIPAL ADMINISTRATIVE ASSOCIATE TITLE. The Office of Revenue Management and Development (ORMD) is a major revenue-producing office within HRA; ... City-tax levy savings for the City. The Bureau of Case Integrity & Eligibility Verification's mission is to identify system enhancements to improve claiming and to… more
    City of New York (07/12/25)
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  • Business Office Manager/ Medical Specialist

    National Health Care Associates (Naugatuck, CT)
    …Beacon Brook Center for Health & Rehabilitation! **-** **Business Office / Medicaid Specialist** **Full-Time** The position is responsible to support the Business ... Office in processing Medicaid Pending Applications, Redeterminations, Applied Income discrepancies and Resident Trust Recommended Minimum Position Qualifications + 1… more
    National Health Care Associates (09/17/25)
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