- Stanford Health Care (Palo Alto, CA)
- …detailed review of medical records. Ensure compliance with Medicare, Medicaid , third-party guidelines, Local Coverage Determinations (LCD), National Coverage ... + Collaboration with Management: Identify and escalate denial patterns to the Manager of Government Audits and Appeals, providing detailed information for follow-up… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE ( Program of All-Inclusive Care for the ... Keeps records and submits reports as assigned by the Manager + Refers high-risk cases to the appropriate FH...a Registered Nurse in a clinical setting required. + 2 years' experience as a Utilization Management/Prior Authorization nurse… more
- Banner Health (Phoenix, AZ)
- …the plan across the continuum of care. 4. Maintains knowledge of Medicare, Medicaid and other program benefits to assist patients with discharge planning ... to achieve the optimal clinical care, financial, operational, and satisfaction outcomes. 2 . Acts in a leadership function with process improvement activities for… more
- Hartford HealthCare (Hartford, CT)
- …with the approved Revenue Compliance Work Plan or as requested by the Manager or Director. . Maintains organized files to support audit observations and drafts ... education on payor rules, requirements and regulatory guidelines (HHS/OIG, Medicare, Medicaid , NGS, Commercial Insurers, etc). . Assists with review and/or… more
- Molina Healthcare (Green Bay, WI)
- …with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the recruitment and orientation of new ... line with industry standards and best practices. * Assists with new program implementation and supports for health plan in-source behavioral health services.… more
- CenterWell (Atlanta, GA)
- …**Required Qualifications** + MD/DO + 8 or more years of technical experience + 2 or more years of project leadership experience + Licensure requirements of the ... of jurisdiction + Graduate of accredited MD or DO program of accredited university + Prefer Internal Medicine specialty...and unrestricted DEA license + Medicare Provider Number + Medicaid Provider Number + Minimum of three to five… more
- Molina Healthcare (San Bernardino, CA)
- …services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality ... leadership and quality improvement teams. * Facilitates conformance to Medicare, Medicaid , NCQA and other regulatory requirements. * Reviews quality referred issues,… more
- Marshfield Clinic (Beaver Dam, WI)
- …any time have been or be excluded from participation in any federally funded program , including Medicare and Medicaid . This is a condition of employment. ... nursing process to assess, plan, implement and evaluate comprehensive patient care. 2 . Works independently within scope of practice to provide safe, optimal patient… more
- HCA Healthcare (San Antonio, TX)
- …assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid time off, ... of various abstracted measures. + Communicatein a timely mannerwith manager to achievemeasure compliance. + Submit datatimelythrough theappropriate reportingsystem.… more
- Veterans Affairs, Veterans Health Administration (Dallas, TX)
- …is accountable to the agency's Chief of Staff and supervised by the Women Veterans Program Manager for VA North Texas Healthcare System. The SW MCC coordinates ... and the need for other non-VA payment options (eg, Medicaid ) to be in place to cover any newborn...and community resources (eg, Women, Infants, and Children (WIC) Program ). Ensures the Veteran schedules postpartum care with the… more
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