- Humana (Des Moines, IA)
- …Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other ... a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines… more
- Public Consulting Group (Des Moines, IA)
- …for scope, schedule, , quality , , communications, risk, and , stakeholder management activities, all while adding deep Medicaid and Medicaid Enterprise ... public sector solutions implementation and operations improvement firm that partners with health , education, and human services agencies to improve lives. Founded in… more
- Mathematica (Des Moines, IA)
- …experience successfully improving state Home- and community-based services within the state's Medicaid or HCBS administrative agencies such as health , human ... and quality monitoring is also preferred. Understanding of dual Medicare- Medicaid eligibility and coordination is preferred, but not required. * Duties of… more
- Mathematica (Des Moines, IA)
- …actionable information to guide decisions in wide-ranging policy areas, from health , education, early childhood, and family support to nutrition, employment, ... firm that is able to define and further our mission, enhance our quality and accountability, and steadily grow our financial strength. Read more about our… more
- Elevance Health (Des Moines, IA)
- Wellpoint, formerly Amerigroup, is a proud member of Elevance Health 's family of brands, offering Medicaid and Medicare plans in several states. We also provide ... who will be responsible for appeals reviews within our Medicaid and Medicare programs.** The **Behavioral Health ...directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes. Identifies… more
- Intermountain Health (Des Moines, IA)
- …Health tools. 6. Completes testing of newly revised or developed processes on SCL Health tools such as the revenue cycle management tool and Epic. 7. Promotes ... mission, vision, and values of SCL Health , and abides by service behavior standards. 8. Performs...+ Understands in depth the processes throughout the Cash Management departments for quality and compliance. +… more
- CVS Health (Des Moines, IA)
- …decision-making. * Monitoring, Evaluation and Documentation of Care: - Utilizes case management and quality management processes in compliance with ... Bring your heart to CVS Health . Every one of us at CVS ...Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex… more
- Access Dubuque (Dubuque, IA)
- …+ Stay abreast of federal, state, and local regulations governing behavioral health services, including HIPAA, Medicaid , Joint Commission, and other relevant ... Director of Compliance & Quality Improvement **Hillcrest Family Services** 1 Positions ID:...+ Thorough understanding of regulatory requirements governing healthcare, includingHIPAA, Medicaid , Joint Commission, and the state mental health… more
- Humana (Des Moines, IA)
- …of data architecture, data quality and related technologies along with data quality management principles + Familiarity with a data quality , analytics ... part of our caring community and help us put health first** The Senior Data Quality /Integrity Engineer...uses that knowledge to design and implement master data management solutions. The Senior Data Quality /Integrity Engineer… more
- Option Care Health (Des Moines, IA)
- …with functions including Operations, Market Access, Internal Audit, Legal, Revenue Cycle Management , Clinical & Quality , Human Resources and Finance and others ... not limited to fraud, waste and abuse; Medicare & Medicaid billing requirements; and interactions with healthcare professionals. +...therapy. With more than 2,900 clinical experts, Option Care Health is able to provide high- quality infusion… more
- Sharecare, Inc. (Des Moines, IA)
- …are committed to supporting each individual through the lens of their personal health and making high- quality care more accessible and affordable for everyone. ... be a legal advisor and regulatory counsel to Sharecare management and staff regarding health care business...business leaders and colleagues on all aspects of home health agencies and healthcare staffing. Experience with Medicaid… more
- Humana (Des Moines, IA)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service ... part of our caring community and help us put health first** The Senior Network Optimization Professional oversees various...integrity as required by CMS, The Ohio Department of Medicaid , and Humana internal reporting compliance. This role will… more
- Trinity Health (Des Moines, IA)
- …to Medicare, Medicaid , VA or Charity Care programs, or patient management and healthcare accounts receivable within the healthcare revenue cycle. Ability to ... volume environment + Team Work Environment + Aligning to the Trinity Health Mission, Vision, and Core Values **SUMMARY** Responsible for coordinating reimbursement… more
- Elevance Health (West Des Moines, IA)
- …government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs. The **Audit and ... Medicaid Services (CMS) division of the Department of Health and Human Services). The Audit and Reimbursement Senior...perform all duties of lower-level positions as directed by management . + Participate in development and maintenance of Audit… more
- Prime Therapeutics (Des Moines, IA)
- …+ 8+ years of pharmacy experience. + 5+ years of experience in Pharmacy Benefits Management (PBM), Health plan or Medicaid clinical customer service. + ... monitor project activities. + Project management experience and knowledge of health plans, PBMs or Medicaid required. **Work Experience** Work Experience -… more
- Humana (Des Moines, IA)
- …relationship across such areas as financial performance, incentive programs, quality management , data sharing, connectivity, documentation, performance, ... part of our caring community and help us put health first** The Senior IT Vendor Management ...need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid… more
- Trinity Health (Des Moines, IA)
- …safety (TogetherSafe) initiatives, and patient safety organization (PSO) collaboration with risk management that ensures high quality and safe care. The ... Clinical Integration Specialist is to assist and support the Director in quality and safety strategies, plans, and regulatory requirements that improve outcomes and… more
- Highmark Health (Des Moines, IA)
- …documentation to improve coding accuracy and thorough capture of members' chronic health conditions. Conducts quality reviews of high-risk and incremental HCCs ... **JOB SUMMARY** This job will deliver value to the Health Plan and its beneficiaries enrolled in risk-adjusted government...coding decision making. Achieves and maintains coding productivity and quality accuracy metrics set by the management … more
- Humana (Des Moines, IA)
- …Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other ... a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines… more
- Humana (Des Moines, IA)
- …Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other ... a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines… more