- Cardinal Health (Lansing, MI)
- …streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, ... a call center or customer service environment, preferred + Clear knowledge of Medicare , Medicaid & Commercial payer policies and guidelines for coverage, preferred +… more
- Henry Ford Health System (Detroit, MI)
- …Under the direction of the department director, the Education Specialist assesses, designs, and evaluates cost-effective, customer-oriented, educational programs ... preventive service guidelines, clinical practice guidelines, behavior change theory, Medicare and Medicaid regulations and case management principles. Knowledge of… more
- Highmark Health (Lansing, MI)
- …requirements and CMS Stars rating measures including HEDIS, CAHPS, Pharmacy , HOS, PQA, PQRS. + Supportdevelopment of the overall conceptualization, ... share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing… more
- CenterWell (Lansing, MI)
- …has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality primary ... Identify and act on opportunities to better manage & coordinate with high-quality specialist , hospital, and community partners to serve patient needs and deepen our… more
- Corewell Health (Grand Rapids, MI)
- …all types of health care fraud including member, employer group, agent, pharmacy , provider, etc. Investigates, collects and documents findings for management review. ... products offered, State and Federal laws related to fraud, waste or abuse, Medicare and Medicaid regulations, etc. + Ability to work effectively with minimal… more
- Molina Healthcare (Ann Arbor, MI)
- …or equivalent experience (such as specialties in: surgical, Ob/Gyn, home health, pharmacy , etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more