- Molina Healthcare (Albuquerque, NM)
- …quality. **Job Duties** + Monitor and Evaluate Calls: Listen to and review Concierge call interactions to assess agent performance against quality standards, ... members, and manager. + Basic understanding of managed healthcare systems and Medicare . **PREFERRED EDUCATION:** Associate or bachelor's degree in social work, Human… more
- Elevance Health (St. Louis, MO)
- ** Medicare Medical Director** Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing ... Candidates must be able to work Eastern Time Zone hours. The ** Medicare Medical Director** is responsible for the administration of physical and/or behavioral… more
- Humana (Sacramento, CA)
- …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about… more
- Humana (Topeka, KS)
- …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
- UPMC (Pittsburgh, PA)
- …UPMC Health Plan is hiring a full-time Telephonic Care Manager to support the Medicare line of business within the Allegheny Care Management Team. The position will ... the Insurance Services Division. **Responsibilities:** + Present complex members for review by the interdisciplinary team summarizing clinical and social history,… more
- ERP International (Laurel, MD)
- …Antonio, TX - plus project locations nationwide. **Responsibilities** + **Regulatory Review and Impact Analysis:** + Analyze CMS laws, regulations, policies, ... + **AI/ML Alignment Support:** + Collaborate with technical teams to extract, review , and validate regulatory data from the Federal Register. + Support AI/ML-related… more
- Centene Corporation (Austin, TX)
- …applicable), peers, and other employees. Work with the training team to create/ review training materials. + Prepare and deliver documents for Program Steering ... required. Healthcare experience and/or managed care experience preferred. Experience with Medicare or CMS bid filing strongly preferred. Pay Range: $86,000.00 -… more
- Fallon Health (Worcester, MA)
- …integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of ... network, thereby reducing their dependence on the medical system. * Offers proactive review of members for a multidisciplinary care planning with PCPs and Care Teams… more
- Specialty Rx, Inc. (Ridgefield Park, NJ)
- Job Description SpecialtyRx is a full-service pharmacy. We need Medicare Part B- Billing Representative with Pharmacy experience in our Ridgefield Park, NJ location. ... and benefits package. Responsibilities: + Experience with billing Part B claims, review and handle denials. + Knowledge with vaccine billing, including Covid. +… more
- Geisinger (Danville, PA)
- …to monitor compliance with applicable research regulations. + Conducts appropriate Medicare Coverage Analysis review process to ensure institutional compliance ... plans. + Assists with development of research auditing and review processes, and independently carries out these audits and...with CMS billing requirements. + Conducts review of conflict of interest disclosures for research investigators,… more
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