- Staffing Solutions Organization (Columbus, OH)
- …diverse workforce, which is a reflection of our clients and the people they serve. ** Onsite Reviewer (OH Department of Medicaid ) in Ohio** **(Location - ... overarching responsibility for this position is to ensure Ohio Medicaid providers are providing a legitimate service,...a comprehensive checklist approved by the Ohio Department of Medicaid (ODM). The Onsite Reviewer … more
- NTT DATA North America (Albany, NY)
- …and forward-thinking organization, apply now. We are currently seeking a Senior Medicaid Salesforce Solution Architect to join our team in Albany, New York ... and have responsibility for design and software development for the Continuing Medicaid Eligibility Modernization program. The mission of the program is to implement… more
- Elevance Health (Winston Salem, NC)
- …locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid . May be responsible ... **Utilization Management Medical Director- NC Medicaid ** Location: This role enables associates to work...Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients'… more
- Elevance Health (Woodbridge, NJ)
- …program. + Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with ... **Behavioral Health Medical Director- Psychiatrist- NJ Medicaid ** Location: The successful candidate will be a...appeal case reviews with attending physicians or other ordering providers to discuss review determinations. + Serves… more
- CareFirst (Baltimore, MD)
- …in determination of appropriateness and authorization of inpatient clinical services. Engages onsite with member, family and providers to identify key strategic ... Clinical Navigator (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely and smooth transition… more
- WMCHealth (Hawthorne, NY)
- Credentialing Specialist- ONSITE Company: NorthEast Provider Solutions Inc. City/State: Hawthorne, NY Category: Clerical/Administrative Support Department: Business ... The Credentialing Specialist -Provider Enrollment position acts as a liaison between providers , revenue cycle and practice operations making sure that all … more
- Highmark Health (Dover, DE)
- …and report improper coordination of benefit billing practices through paid clams review . + Participate as pharmacy representative in onsite member appeals ... and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal… more
- Deschutes County (Bend, OR)
- …applying as a Behavorial Health Specialist II, Licensed, Deschutes County's Mental Health providers serving Medicaid members must be enrolled with the Oregon ... oriented services in behavioral healthcare settings co-located with physical health providers . To hear from staff about working at Deschutes County Behavioral… more
- University of Southern Mississippi (Hattiesburg, MS)
- …in Mississippi by providing training, consultation, and curriculum development to Medicaid Home and Community-Based Services (HCBS) providers . The individual ... initiative and the Mississippi Training Institute. + Provide regular coaching and onsite and virtual technical assistance support to providers involved in… more
- Cuyahoga County Board of Developmental Disabilities (Cleveland, OH)
- …in choosing providers as needed. + Assist with enrollment onto Medicaid waivers as appropriate. Complete all related paperwork accurately and in a timely ... obtain services and supports. Implement an ongoing system of review . The nature of work will include, but is...as needed. + Establish and maintain contact with service providers and natural supports as necessary to ensure that… more
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