- CenCal Health (Santa Barbara, CA)
- …departments and external partners to ensure compliance with Medi-Cal and Medicare regulatory and contractual requirements, and operational plan requirements, as well ... proposing recommendations for improvement. Contribute in the new implementation and review of documented audit processes to ensure compliance against requirements… more
- Southeast Texas HR (Beaumont, TX)
- …is a full-time day position. Pay will start at $15.81+ per hour. Responsibilities Review and correct all Medicare claims daily. Verify and update information to ... ensure accurate patient billing records. Review all Medicare remittance reports for errors, denials, and incorrect payments. Review and track all aging… more
- Molina Healthcare (Long Beach, CA)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... and measuring performance metrics regarding patient outcomes, medications safety and medication use policies). KNOWLEDGE/SKILLS/ABILITIES Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State… more
- Actalent (Fort Lauderdale, FL)
- …in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ensuring smooth ... patient satisfaction, safety, and appropriate length of stay. Responsibilities Review prior authorization requests for medical necessity and appropriateness using… more
- FROEDTERT HEALTH (Milwaukee, WI)
- …Refers cases to the physician advisor, PA moonlighter, for a second level review as needed. Facilitates communication with service based multidisciplinary team as it ... Bachelor's Degree in Nursing is preferred. SPECIAL SKILLS DESCRIPTION: Knowledge of Medicare inpatient only surgical list, Medicare guidelines for admission,… more
- Hackensack Meridian Health (Hackensack, NJ)
- Overview The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical ... Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions of care,… more
- Molina Healthcare (Long Beach, CA)
- …the Company's assigned contact to log tickets for premium restoration such as Medicare Secondary Payer and ESRD. JOB QUALIFICATIONS Required Education HS Diploma or ... GED Required Experience 1-3 years' experience in an administrative support. Preferred Education Associate degree Preferred Experience 3+ years' experience in an administrative support role. To all current Molina employees: If you are interested in applying for… more
- DHR Health (Edinburg, TX)
- …and review processes highly desirable. Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to utilization review ... to issue Hospital Issued Notice of Non-coverage and Hospital Requested Review for Medicare patients according to policy. Refers cases not meeting criteria… more
- Texas Health Resources (Arlington, TX)
- …programs. Manges outside consulting relationships including but not limited to the review and preparation on of Medicare /Medicaid cost reports, regulation ... and other programs. Oversees or supports departments and entities with various Medicare and Medicaid Supplemental Payment and incentive programs including but not… more
- South Orange County Community College District (Mission Viejo, CA)
- …Meet workload obligations. Maintain accurate records. May participate in curriculum review and program development. Assignments may include day, evening, weekend, ... of eligible retirees, shall continue until the retiree reaches the age of Medicare eligibility. The retiree may be eligible for continued benefits after reaching the… more
- Optum (San Antonio, TX)
- …with Microsoft Office, Internet and e-mail Beginner level of knowledge of the Medicare Part D, particularly the pharmacy record review , claims, billing and ... information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing...to internal staff, subcontractors and providers with respect to Medicare drug related issues May serve as a subject… more
- Optum (San Antonio, TX)
- …years of experience in a customer service setting 6+ months of experience with Medicare Part D, particularly the pharmacy record review , claims, billing and ... record with accurate information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing and that payment made… more
- MBK Senior Living (Scottsdale, AZ)
- …(serving from the left, clearing used dishes between courses, etc.) 100% - Review residents dietary needs, as outlined by Supervisor 5% - Track resident attendance ... provide care and services in a facility that receives Medicare or Medicaid funding. If employed at one of...at one of our senior living communities that receives Medicare or Medicaid funding, team members must not be… more
- Optum (San Antonio, TX)
- …years of experience in a customer service setting 1+ years of experience with Medicare Part D, particularly the pharmacy record review , claims, billing, and ... information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing...to internal staff, subcontractors and providers with respect to Medicare drug related issues May serve as a subject… more
- MBK Senior Living (Manteca, CA)
- …AFG nurse case manager - Draft initial service plans for new residents; review with responsible parties and Executive Director *Service Plans will be established for ... staff in accordance with community policies, procedures and established budgets *daily review of timekeeping, meal breaks and overtime *conduct orientation for new… more
- Caresense Home Health (Montgomeryville, PA)
- …projects *Establish and develop Company policies and procedures *Assist with Medicare and Medicaid related tasks *Building and retaining relationships with referral ... employees, clients and their families *Internal case management, documentation review , determining program eligibility and payer source, insurance authorizations,… more
- Stony Brook Medicine (Stony Brook, NY)
- …Department may include the following but are not limited to: Completes Utilization review screen for inpatient and observation cases. Activity includes UR from the ... Follows cases for authorization for in patient stay. Staff review short stay, long stay and complex cases to...days. Documents over utilization of resources and services. All Medicare cases are reviewed for level of care on… more
- SCAN (Sacramento, CA)
- …member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 300,000 members in California, Arizona, Texas ... listed above. 3-5 years' previous outside sales or Outreach experience within the Medicare community, required. 3-5 years' experience with MS Office - Excel (data… more
- AdaptHealth LLC (West Berlin, NJ)
- …to appropriate resource, and follow up on customer calls where necessary Review all required documentation to ensure accuracy Accurately process, verify, and/or ... multiple online EMR systems to obtain applicable documentation Enter and review all pertinent information in EMR system including authorizations and expiration… more
- City of El Segundo, CA (El Segundo, CA)
- …may close at any time. Interested candidates should apply immediately. The first review of applications will be on Monday, August 18, 2025. This recruitment requires ... considered complete. Applicants appearing best qualified based upon a review of the application materials will be invited to...Single highest year is coordinated with Social Security and Medicare . PERS 2%@62 for new employees/members hired on or… more
