- Kaiser Permanente (Arlington, VA)
- …inappropriate utilization of medical services. In close collaboration with the nurse case manager and other members of the health care team, develops and monitors a ... Ensures consistent and reliable documentation of case management activities in compliance with all organization and department standards. Analyzes patient and… more
- ARTHRITIS & RHEUMATISM ASSOCIATES P (Chevy Chase, MD)
- …care and patient care management. SUPERVISION RECEIVED: Reports directly to the MA Manager /Clinical Quality Assurance Manager , Office Manager , and Director ... current with the policies mandated by Federal and local governments, Medicare/ Medicaid programs and other private healthcare programs regarding handling of… more
- Sumitomo Pharma (Annapolis, MD)
- …dynamic, highly motivated, and experienced individual for the position of Sr. Manager , Medicaid Contract Administration. This position is responsible for ... managing the Medicaid rebate team in receiving, processing, validating, trouble-shooting ...with internal departments (Internal Audit, Commercial Insights, Contracting, SOX Compliance , and Legal) to clarify policy compliance … more
- Humana (Annapolis, MD)
- …development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root ... a part of our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence… more
- Prime Therapeutics (Annapolis, MD)
- … with federal laws, state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each State Medicaid ... passion and drives every decision we make. **Job Posting Title** Manager Rebate Pharmacy Operations **Job Description Summary** This position provides administrative… more
- Humana (Alexandria, VA)
- …our caring community and help us put health first** The Field Care Manager , Behavioral Health performs primarily face to face and telephonic assessments with ... members. The Field Care Manager serves as the primary point of contact. providing...behavioral health outcomes, reducing care gaps, and supporting Virginia's Medicaid population with comprehensive, integrated behavioral health care management..… more
- Mindoula Health (Largo, MD)
- …administrative/operational flow of participants into the program. Further, serves as case manager for clients with mental illness and/or substance use disorders as ... Functions is split into (1) Program Coordination-specific functions and (2) Case Manager -specific functions. Location This is a hybrid position, with from home and… more
- Humana (Arlington, VA)
- …of our caring community and help us put health first** The Field Care Manager , ARTS assesses and evaluates member's needs and requirements to achieve and/or maintain ... the care and wellbeing of members. The Field Care Manager , Behavioral Health 2 work assignments are varied and...needs. + Will follow processes, and procedures to ensure compliance with regulatory requirements by the Virginia Department of… more
- Genesis Healthcare (Silver Spring, MD)
- …this sound like you? If so, apply to join our team as a **Business Office Manager ** and take the lead in driving financial excellence at the center level! This is ... mission of delivering exceptional care. **What You'll Do:** As a Business Office Manager , you'll oversee the full spectrum of revenue cycle management functions -… more
- Datavant (Annapolis, MD)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Analytics Products, you will contribute to the strategy and ... and support value-based client delivery across Medicare Advantage, ACA, and Medicaid programs. The ideal candidate combines deep healthcare analytics expertise with… more
- Humana (Annapolis, MD)
- …a part of our caring community and help us put health first** The Manager , Technology Solutions devises an effective strategy for executing and delivering on IT ... business initiatives. The Manager , We are seeking a highly skilled and motivated...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Humana (Annapolis, MD)
- …help us put health first** Humana's Marketing organization is seeking a Senior Product Manager who specializes in Next Best Action (NBA) execution to join the team ... a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Annapolis, MD)
- …us put health first** We're seeking a strategic, results-driven Lead Product Manager to design and deliver innovative clinical solutions that improve health outcomes ... a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Cardinal Health (Annapolis, MD)
- …* Process all patient applications in accordance to set policy, procedures and PHI compliance * Speak with manufacturer field team members on case updates via phone ... benefits management experience preferred with specific knowledge of Medicare, Medicaid and commercially insured payer common practices and policies, preferred… more
- CVS Health (Annapolis, MD)
- …Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in both Medicare and Medicaid . As a member of the care team, you will collaborate with members, the ... coordinating care for our members through close collaboration with the Care Manager , Social Worker, and other interdisciplinary team members. This role involves… more
- Service Source (Arlington, VA)
- …to social, community inclusion, communication, behavior, and skill development. Ensure compliance with all State and Federal regulatory guidelines, including ... Medicaid , Licensure, and Commission on Accreditation of Rehabilitation Facilities...report any unsafe conditions, medical concerns to the Program Manager or designee. Follow established written protocols and plans.… more
- Compass Maryland (Beltsville, MD)
- …Engagement programs. This cross-functional role ensures program integrity, documentation compliance , data system accuracy, and team collaboration, while assisting ... new systems and procedures as needed to ensure improved efficiency and compliance with overall program operations including data collection, attendance recording and… more
- Trinity Health (Silver Spring, MD)
- …survey readiness and promote a culture of continuous regulatory compliance and quality improvement. **Job Title: Regulatory, Accreditation Coordinator** **Employment ... from agencies such as The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and state health departments in collaboration with the Manager… more
- CenterWell (Annapolis, MD)
- …CenterWell ACO and Medicare payment model programs via the Center for Medicare and Medicaid Services (CMS), such as ACO REACH, MSSP, and future models. Under general ... operations including program administration, contract oversight, process, performance improvement, compliance , governance, training, and more. Additionally, this role will… more
- Fresenius Medical Center (Fort Washington, MD)
- …nurse in accordance with organization policies, procedures, and training and in compliance with regulations set forth by the corporation, state, and federal ... under the supervision of a nurse. + Collaborates with the Clinical Manager and Education Coordinator in driving organization quality standards through education… more
