- Molina Healthcare (Fort Worth, TX)
- …clinical leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. * Reviews quality ... referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy… more
- BrightSpring Health Services (Phoenix, AZ)
- …care initiation to meet financial and clinical goals. + Ensure compliance with Medicare , Medicaid, and state regulations. + Perform clinical duties as assigned or ... needed, according to discipline, regularly to model best practice. + Recruit, hire, train, and develop staff to maintain quality and safety standards. + Conduct audits, quality assurance, and performance evaluations. + Drive marketing and community outreach to… more
- NHS Management, LLC (Vestavia Hills, AL)
- …billing and collection experience with nursing home receivable which includes Medicaid and Medicare Part A & B, HMO's + Experience with Medicaid Applications + ... Strong organization skills including the ability to prioritize and manage multiple tasks in a dynamic environment + Strong analytical skills; ability to quickly identify problems and find effective solutions + Strong written and oral communication skills +… more
- AdventHealth (Burleson, TX)
- …comply with external accreditation standards, state and federal laws, and Medicare conditions of participation. This role ensures administrative interface with the ... community, including members of the medical and allied health staff, medical staff leadership, related offices, health agencies, and the public. In addition, this position assures and establishes rapport, maintains effective lines of communication, and… more
- Catholic Health Initiatives (Little Rock, AR)
- …Based Agreements (VBAs) with governmental (CMS and state for Medicare Shared Savings-Accountable Care Organization/MSSP-ACO and Medicaid), private insurers (for ... MA, fully insured and health insurance exchange) and self-insured commercial populations of a total over 200,000 "lives." The SEVH contains CINs that have industry's and CommonSpirit's best-practices in Risk Score performances in MSSP-ACO, Annual Wellness… more
- The Cigna Group (Bloomfield, CT)
- …marketing, sales, and business acumen experience a plus. + Fluency in Spanish (Cigna Medicare ) or other languages If you will be working at home occasionally or ... permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 206,300 - 343,900 USD /… more
- WellSpan Health (Lebanon, PA)
- …health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region's largest and ... one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000… more
- Bear Mountain Health Care (Springfield, MA)
- …years supervisory experience in long term care + Strong knowledge of Medicare /Medicaid/Joint Commission guidelines required + Must be computer literate. Knowledge of ... EMR required ESSENTIAL DUTIES AND RESPONSIBILITIES: + Provides guidance and direction to ancillary staff in both clinical and personnel issues + Assist staff in assessing patient/resident status related to medical issues, social psychological and spiritual… more
- Banner Health (Scottsdale, AZ)
- …health care services. 8. Assures compliance with all regulatory bodies, including Medicare , State, Joint Commission and CMS, as applicable. Assures that standards ... are met. 9. This position has direct responsibilities for the designated service line/division. This position has full latitude to actively make decisions and choices which adhere to the mission and values of the organization while following all regulatory and… more
- Ochsner Health (New Orleans, LA)
- …with accreditation standards, state and federal licensure or regulations, Medicare , Medicaid, and other regulations, guidelines, requirements, and statutes as ... applicable. The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time. Remains knowledgeable… more