- Intermountain Health (South Jordan, UT)
- …verifies medical necessity, and maintains clear communication throughout the order process . The coordinator manages patient orders from start to finish, including ... external relationships, and demonstrates problem-solving and compliance knowledge, including Medicare/ Medicaid billing and privacy regulations. + Audits casework and… more
- Commonwealth Care Alliance (Boston, MA)
- …* Maintain up-to-date knowledge of and compliance with CMS, NCQA and state Medicaid requirements. * Lead preparation for internal and external audits (eg ... teams to support care coordination and integrated care. * Manages the process for escalated reviews in accordance with Standard Operating Procedures. * Provides… more
- Humana (Nashville, TN)
- …to, PowerBI, Alteryx, Tableau, SQL, R & Python + Six Sigma Black Belt, Process Improvement and/or Quality Control expertise + Familiarity with Generative AI and ... Internal Audit. The Director Internal Audit will develop and lead risk based operational audits and consulting projects to...progressive thinking with a keen eye for improving business process and risk management and must be agile and… more
- MyFlorida (Fort Lauderdale, FL)
- …address identified concerns, collaborating with external stakeholders including the Quality Improvement Organization (QIO), Medicaid Program Integrity (MPI) and ... team members who demonstrate the qualities of being humble, hungry, and smart and lead others to embody the same. This entails lacking excessive ego, sharing credit,… more
- Boehringer Ingelheim (Ridgefield, CT)
- …department communication and projects. + Lead team toward continuous improvement and/or process design through analysis of existing processes. Facilitate ... the identification and implementation of process and procedures geared towards improving efficiency and productivity within the group. + Partner with the BIPI… more
- State of Colorado (Denver, CO)
- …Analyze program efficiency and effectiveness, identify and define areas for Improvement , and ensure that solutions are implemented and monitored for effectiveness ... CDHS Behavioral Health Administration, and the Centers for Medicare and Medicaid Services. Utilize hospital quality management resources to monitor hospital… more
- Humana (Frankfort, KY)
- …emotional intelligence and resultsorientation. + Demonstrated expertise in consumer research, process improvement , change management, and strategy development. + ... Associate Vice President, Experience Design - Insurance Product Experience to help lead that transformation. Position Overview: The role will serve as a strategic… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …in good standing. Key Responsibilities ESSENTIAL JOB FUNCTIONS: **CLINICAL EFFECTIVENESS:** * Lead in clinical process design/ improvement sessions * ... the segmentation of concurrent review offerings into Medicare / Medicaid / Commercial Payors, as needed * Reviews medical...improvement measures of HCAHPS percentile score for discharge process * Adhere to the standards of employee conduct… more
- MyFlorida (Tallahassee, FL)
- …of Florida, including in areas of criminal appeals, civil litigation, consumer protection, Medicaid fraud, and victims and civil rights. We invite you to visit our ... detailed: 0 - 17 Unsatisfactory 18 - 26 Needs Improvement 27 - 32 Meets 33 - 40 Commendable...collect and identify patterns of consumer complaints that may lead to investigation or action by the agency. In… more
- Molina Healthcare (GA)
- …leading a continuous process of innovation to identify new initiatives which lead to the overall improvement of population health management, reduction of ... IT and analytics tools to support current and new value based programs. Lead identification of target providers and payment innovation models for VBP, creates models… more