- Corewell Health (Grand Rapids, MI)
- …also ensures that LTSS operations align with the integration of Medicare and Medicaid benefits under Michigan's HIDE SNP model, meeting CMS and MDHHS expectations ... external partners and reports directly to the Senior Director of Utilization Management . Essential Functions Strategic Leadership & Program Oversight: + Develop and… more
- CVS Health (Columbia, SC)
- …+ Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. + Familiarity with community ... home healthcare coordination experience **Preferred Qualifications** + Experience providing care management for Medicare and/or Medicaid members. + Experience… more
- CVS Health (Albany, NY)
- …* Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. * Familiarity with community ... home healthcare coordination experience **Preferred Qualifications** * Experience providing care management for Medicare and/or Medicaid members. * Experience… more
- CVS Health (Blue Bell, PA)
- …the operational and financial performance evaluation across Aetna's Commercial and Medicaid Care Management programs to optimize the programs' performance, ... for building and maintaining staffing models that support the Commercial and Medicaid Care Management programs. Key responsibilities of this role include:… more
- CVS Health (Lexington, KY)
- …Special Needs Plan (DSNP) members, who are enrolled in both Medicare and Medicaid and face a variety of complex health and social challenges. Through compassionate ... locations, medical facilities, and other locations. + Completing care management focused assessments. + Setting member-centered goals. + Identifying barriers… more
- CVS Health (Helena, MT)
- …to join it's CVS Health's leadership team as a Director, Pharmacy Benefit Management (PBM) Underwriting, Analysis and Strategy. In this role, you will lead a ... and maintaining a deep understanding of PBM financial levers within Commercial, Medicaid , Medicare Part D, and Public Exchange lines of business. + Conduct… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …On and Off Marketplace health insurance products, including Child Health Plus (CHP), Medicaid Managed Care (MA/MMC), Essential Plan (EP) and the Individual Market - ... outreach and community events. Essential Accountabilities: Level I * Educates Medicaid , Medicare, and Commercial members on healthcare benefits, and community… more
- CVS Health (Springfield, IL)
- …PBM. In this role you may provide consultative clinical support to Account Management in support of Key Clients as assigned. The Medical Director transacts ... Utilization Management UM activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to… more
- Baylor Scott & White Health (Dallas, TX)
- …no matter where you are on your journey. For full details on coverage and eligibility , visit the Baylor Scott & White Benefits Hub to explore our offerings, which ... may include: + Eligibility on day 1 for all benefits + Dollar-for-dollar...such as the Joint Commission, Centers for Medicare and Medicaid (CMS), National Committee for Quality Assurance (NCQA), Health… more
- HCA Healthcare (Tampa, FL)
- …full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility , for external clients across the country. Parallon has over ... on income. Learn more about Employee Benefits (https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards) **_Note: Eligibility for benefits may vary by location._** You contribute… more