- Molina Healthcare (Fremont, NE)
- …Healthcare of Nebraska** is seeking a dynamic **Sr Community Engagement & Growth Specialist in/near the Norfolk or Freemont areas.** There may be occasional visits ... community-based organizations and providers to promote Molina's services. The Sr Specialist will collaborate with internal teams (Quality, Provider Relations, … more
- AdventHealth (Hinsdale, IL)
- …are provided and documented in a timely manner for compliance: Important Medicare Letters (IML), Medicare Outpatient Observation Notice (MOON), Patient Choice, ... primary care physician identification and scheduling of follow-up PCP and specialist appointments for posthospital follow up care. Ensures discharge disposition… more
- St Croix Hospice (Delavan, WI)
- …approved certifying body for advanced practice nursing as required by State. + Certification in a specialist area preferred; (eg Hospice and Palliative Nursing ... the hospice medical director for interpretation for eligibility for hospice re- certification . + Makes recommendations to the hospice medical director regarding… more
- Banner Health (Phoenix, AZ)
- …preparing and delivering reports and presentations, analyzing, developing, and/or submitting Medicare Advantage and Prescription Drug plan bid pricing tools and/or ... leadership. Will direct the preparation of rate filings to Centers for Medicare and Medicaid Services (CMS), Health and Human Services (HHS), Arizona's Medicaid… more
- Humana (Annapolis, MD)
- …approvals, as well as modeling financial impact of emerging therapeutics across Medicare and Medicaid LOBs + Researches and analyzes drugs and emerging therapeutics, ... + PharmD + Health Plan experience + Knowledge of Medicare as it relates to pharmacy + Six Sigma...to pharmacy + Six Sigma and/or Project Management Professional certification + Pharmacy practice residency or similar pharmacy practice… more
- Molina Healthcare (Carson City, NV)
- …business. + Certified Business Analysis Professional (CBAP), or Certified Coding Specialist (CCS) certification . + Project Management Experience. + Familiarity ... and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements...At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …when appropriate * Collaborates with department director and professional development specialist to develop standard work and expectations for the utilization review ... compliance to regulatory and health plan requirements for authorization, including Medicare Inpatient Only List and communicates to provider to obtain accurate… more
- HCA Healthcare (San Antonio, TX)
- …preferred banking partnerships + Education assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time ... regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist ) to ensure the medical records reflect compliance with medical necessity,… more
- Banner Health (GA)
- …highly trained staff. Banner Health recently earned Great Place To Work(R) Certification (TM) . This recognition reflects our investment in workplace excellence and ... as defined in minimum qualifications below. Please upload a copy or provide certification number in your questionnaire.** **Please note, this is a COMPLEX role,… more
- Evolent (Helena, MT)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... state licensure required per business needs + Active Board Certification in Interventional Cardiology **or** may be substituted for...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more