- Elevance Health (Washington, DC)
- …with team members to provide superior customer services. + Supports Health Management Programs. + Conducts research to assist customers with inquiries or issues. ... Comprehends the various cultural and linguistic needs of the Medicaid and SCHIP population, knowledge of the various health...partners. + Mentors and coaches Outreach staff. + Generates management reports. + Associates in this role are expected… more
- CVS Health (Columbus, OH)
- …and/or state government agencies, including but not limited to the Center for Medicaid and Medicare (CMS), Department of Public Welfare, Department of Health, and ... and escalating more complex issues and concerns to upper management for resolution. + Compiles reports on quality metrics...of Grievance and Appeals Experience + 1+ Medicare and/or Medicaid experience **Education** + High School Diploma or GED… more
- Community Health Systems (Powell, TN)
- …+ Ensures compliance with policies and regulatory requirements related to Medicaid eligibility , insurance verification, prior authorizations, medical necessity, ... policies and standards. **Leadership Responsibilities** + **Supervision and Staff Management ** + Provides leadership, mentorship and professional development opportunities… more
- Centene Corporation (Brooklyn, NY)
- …Community position for Brooklyn, NY** **Enroll members into various Fidelis Medicaid , CHP, EP plans** **Position Purpose:** The Health Benefit Representative (HBR) ... offered through the New York State of Health (NYSOH), Medicaid Managed Care, Child Health Plus, Medicare, MLTC, FIDA...manage their calendar and report on activity to their management . They also are fluent and can articulate the… more
- CVS Health (Hartford, CT)
- …for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent focused ... and predetermination of covered benefits in the commercial, Medicare, and Medicaid environment. This Wheelchair DME consultant provides subject matter expertise in… more
- CVS Health (Woonsocket, RI)
- …leadership. You will be responsible for drafting and negotiating prescription benefit management (PBM) contracts with CVS Health's health plan client. In this role ... possess a basic knowledge of healthcare laws and regulations, including HIPAA, Medicare, Medicaid , the False Claims Act, and the Federal Anti-Kickback Statute + You… more
- Fallon Health (Worcester, MA)
- …who have MassHealth Standard, and may have Medicare. It combines MassHealth ( Medicaid ) and Medicare benefits, including prescription drug coverage. At Fallon Health, ... to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE- in the region. **Brief Summary of Purpose:** The… more
- CVS Health (Baton Rouge, LA)
- …presentations that support member education and health plan awareness within the Medicaid or Medicare population and the community. This person develops and ... with community outreach and/or event planning. + 3-5 years of previous Medicaid experience. + Working knowledge of Microsoft Office products (Word, Excel,… more
- TEKsystems (Morrisville, NC)
- …+ Strong understanding of reimbursement processes and major payers (Medicare, Medicaid , VA, DOD, commercial) + Experience with prior authorizations, insurance ... skills + Professional, dependable, and organized with excellent time management + Positive, flexible, and eager to learn and...| Medical Claims | Insurance Verification | Medicare & Medicaid | Bilingual Communication | Patient Access | Case… more
- Devereux Advanced Behavioral Health (Orlando, FL)
- …provides mental and behavioral health services as well as child welfare case management services for children, adolescents and adults whose needs are extra ordinary. ... Perform other duties as assigned by the Supervisor or Management . + Complete credentialing for new MDs and ARNPs...and ARNPs joining MMA plans. + Apply for Florida Medicaid numbers for providers during onboarding. + Complete special… more