- Centene Corporation (Dover, DE)
- …cost containment, and quality improvement activities within the LTSS and Medicare -Medicaid Duals populations. + Review complex, controversial, or experimental ... initiatives for both the Long-Term Services and Supports (LTSS) and Medicare -Medicaid Duals populations. Additionally, the Medical Director will collaborate with… more
- Trinity Health (South Bend, IN)
- …third party payer authorizations, referrals) and will contact the physician /office and Case Management/Utilization Review colleagues as necessary. ... with a payment receipt in the collection of funds. Validates medical necessity (LCD/NCD review ) of Medicare and Non- Medicare cases to ensure clinical and… more
- Goodwin Living (Washington, DC)
- …District of Columbia About the Position Evaluates residents, under physician referral, with swallowing and communication disorders. Develops effective treatment ... plans and obtains approval for services from referring physician . Manages schedule per scheduling policy, communicating any issues...coordinator as per policy. Completes all required assessments for Medicare skilled/ Medicare A and Medicare … more
- Johns Hopkins University (Baltimore, MD)
- …other related regulatory matters. + Oversees the management of the quality assurance review program to continuously assess physician and non- physician ... Health System (JHHS), Legal Department and Corporate Compliance Department, JHHS physician entity leadership, Revenue Cycle leadership, and SOM clinical department… more
- UPMC (Pittsburgh, PA)
- …of topics affecting the financial performance of the health plan; assist with reconciling Medicare Advantage Part C and Part D claims data to financials; analyze bid ... changes; develop assumptions, project costs and monitor emerging experience of Medicare Advantage Mandatory Supplemental Benefits including, but not limited to,… more
- AdventHealth (Hinsdale, IL)
- …insured and, if so, gathers details (eg, insurer name, plan subscriber) + Performs Medicare compliance review on all applicable Medicare accounts in order ... patients + Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility… more
- Beth Israel Lahey Health (Charlestown, MA)
- …includes academic medical centers, acute and specialty hospitals, outpatient facilities, physician groups, performance networks, and community partners. As part of ... and analytics that deliver actionable business insights to BILH hospital, physician , and system leaders; (3) Provide strategic solutions that optimize reimbursements… more
- Humana (Concord, NH)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, DME, skilled nursing facility and… more
- Sharp HealthCare (San Diego, CA)
- …+ Supports pre-admission review , utilization management, and concurrent and retrospective review Process. Performs and mentor's physician training of A&G and ... physicians (Medical Directors (both medical and behavioral health) and the Physician Reviewers) to coordinate the necessary co-management of our members related… more
- Amgen (Chicago, IL)
- …HUB, providing live one-on-one coverage support + Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer ... prior authorization to appeals/denials requirements and forms. + Review patient-specific information in cases where the site has...the products are covered under the benefit design (Commercial, Medicare , Medicaid). + Serve as a payer expert for… more