• Utilization Management Specialist - FT Days

    Sanford Health (Sioux Falls, SD)
    …with professional standards, national and local coverage determinations (NCD/LCD), centers for Medicare and Medicaid services (CMS), as well as state and federal ... clinical units are required. **Qualifications** Bachelor's degree in nursing preferred . Graduate from a nationally accredited nursing program required, including,… more
    Sanford Health (10/08/25)
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  • Clinical Pharmacy Specialist - Ambulatory…

    Sanford Health (Fargo, ND)
    …as requested by the clinic support staff. o Conduct Office Visits or Medicare Annual Wellness Visits at assigned clinic(s) o Assist patients who cannot afford ... their actions; knowledge of state and local regulations. Hospital experience or residency preferred . License must be in good standing by the State Board of Pharmacy… more
    Sanford Health (10/07/25)
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  • Medical Billing Specialist - McLaren…

    McLaren Health Care (Pontiac, MI)
    …collect payment on medical bills and post to accounts. 2. May update Medicare and Medicaid cost and bad-debt reports, billing, collection and other related ... information. 9. May work with providers to identify the appropriate codes in selecting the patients' care plans, associated orders for treatment and any co-morbid conditions. Provides continuous education on the appropriate documentation to support all codes… more
    McLaren Health Care (09/30/25)
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  • Senior Specialist , Government Contracts…

    Molina Healthcare (Milwaukee, WI)
    …administration of contracts with State and/or Federal governments for Medicaid, Medicare , Marketplace, and other government-sponsored programs to provide health care ... (or similar reporting tools), SQL query, MS Access, and MS Excel. ** Preferred Education** Bachelor's Degree in Business Administration, Healthcare, or related field.… more
    Molina Healthcare (09/27/25)
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  • Coding Education & Compliance Specialist

    Health Care Service Corporation (Harlingen, TX)
    …+ Ability to travel 20% - 30% of the time in and out of state ** PREFERRED JOB REQUIREMENTS:** + Associate or Bachelor's degree + CRC + Experience in health insurance ... + Previous experience working on Risk Adjustment coding for either Medicare Advantage or Retail Exchange business + Prior experiences teaching/training others… more
    Health Care Service Corporation (09/27/25)
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  • Member Engagement Specialist - Davidson…

    Wider Circle (Southmont, NC)
    …phone or video conferencing. + A genuine interest in working with Medicare /DSNP/Medicaid populations and a commitment to building strong, supportive relationships. + ... hours) and reliable transportation when necessary. + 3-5 years relevant experience. Preferred Requirements + Associate or Bachelor Degree + 3+ years of relevant… more
    Wider Circle (09/22/25)
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  • Provider Contracting Specialist - (Remote)

    CareFirst (Baltimore, MD)
    …year experience in contracting, provider recruitment or provider relations. ** Preferred Qualifications:** + Master's degree in Business or Healthcare Administration. ... + Knowledge of healthcare or health insurance payor industry ( Medicare , Medicaid, Commercial, DSNP and other payor programs), including legal and regulatory… more
    CareFirst (09/18/25)
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  • Billing Specialist - Audit/ Claims Review

    AnMed Health (Anderson, SC)
    …insurance payer audits. + Responsible for quarterly compliance reporting and quarterly Medicare and Medicaid credit balance reports. + Work credit balances for all ... skills, both written and verbal. + Prior experience working with the public. Preferred Qualifications + Prior electronic and/or hard copy billing. + Knowledge of… more
    AnMed Health (09/17/25)
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  • Behavioral Health Outreach and Intake…

    Northeast Alabama Regional Medical Center (Anniston, AL)
    …tool and any other approved assessment tools. Knowledge of Social Security, Medicare and Medicaid and insurance for behavioral health or experience with legal ... crisis intervention experience with a psychiatric mental health population, preferably in an inpatient setting. Marketing and community outreach experience preferred more
    Northeast Alabama Regional Medical Center (09/17/25)
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  • Outpatient Adult Clinical Documentation Integrity…

    UCLA Health (Los Angeles, CA)
    …collaborative, self-directed individual with: * Bachelor's degree in health-related field, preferred * A Registered Nurse (RN) license or MD diploma (or ... of laws, rules and regulations regarding appropriate clinical documentation for Medicare , Medi-Cal, CCS etc. * Strong leadership, supervisory, and training skills… more
    UCLA Health (09/17/25)
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