- 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
- Staffing Solutions Organization (Albany, NY)
- …This position is within the Housing Unit. The incumbent will oversee housing providers that are contracted to assist vulnerable Medicaid members in obtaining ... of Program Development & Management (DPDM)** **Item 1203** **50% Onsite 50% Remote** **Summary:** The Bureau of Social Care...Voucher reconciliation of the fiscal submissions made by housing providers + Review and submit budgets and… more
- NTT DATA North America (Albany, NY)
- …adaptable, and forward-thinking organization, apply now. We are currently seeking a Senior Medicaid Solution Architect to join our team in Albany, New York (US-NY), ... 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 (Indianapolis, IN)
- …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 - Indiana Medicaid ** **Location:** This role enables associates to work...appeal case reviews with attending physicians or other ordering providers to discuss review determinations. + Serves… 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 ... **Resp & Qualifications** **PURPOSE:** The Onsite Clinical Navigator (RN) embedded at a partnering...(RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely… 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
- Conduent (Helena, MT)
- …Career Opportunities, a Great Culture, and Great Benefits!** Interested in supporting Medicaid Providers in Montana? Conduent has immediate openings. This is ... is noticed and valued every day. **This is an onsite position** **No Weekends - Flexible Work Schedule** **Payrate:...a great opportunity to learn about Medicaid Provider support and the medical eligibility and claims… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Primary activities include substantiating referrals, case planning and research, conducting onsite or desk audits, clinical reviews of medical records to ensure ... agencies. Essential Accountabilities: Level I + Functions as a clinical reviewer of medical records, researching and investigating complex medical cases. Interprets… more
- Evolent (Oklahoma City, OK)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. ... for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a meaningful impact… more
- Actalent (Portland, OR)
- …with healthcare providers and the authorization team to ensure timely review of services, ensuring members receive authorized care. + Coordinate with healthcare ... Job Title: Medical Authorization Review Specialist Job Description We are seeking a...providers and interdepartmental teams to assess the medical necessity… more
- Evolent (Albany, NY)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. ... Will Be Doing:** + Serve as the Physician match reviewer in Imaging cases, that do not initially meet...necessity guidelines, as well as other imaging requests when providers , clients, or state laws require specialty reviews to… more
- Evolent (Tallahassee, FL)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. ... Will Be Doing:** + Serve as the specialty match reviewer in Cardiology cases, that do not initially meet...medical necessity guidelines, as well as other requests when providers , clients, or state laws require specialty reviews to… more
- Evolent (Helena, MT)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. ... Will Be Doing:** . Serve as the Physician match reviewer in Advanced Imaging cases, that do not initially...necessity guidelines, as well as other imaging requests when providers , clients, or state laws require specialty reviews to… more
- Highmark Health (Nashville, TN)
- …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
- Philips (Malvern, PA)
- …issues facing sales, services, billing and reimbursement, and interactions with healthcare providers and professionals. Also, you will lead and be responsible for ... objective investigations from intake through resolution. Act as an independent reviewer to ensure compliance concerns are appropriately evaluated, investigated, and… 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
- 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
- Helio Health Inc. (Syracuse, NY)
- …clinical data into our HIT system necessary to for our team of healthcare providers . This position will work on a Full-Timebasis out of ourWillows Program. In ... + Collect co-pays, self-pays and produce cash receipts. + Review other methods of payment such as third-party and... other methods of payment such as third-party and Medicaid . + Assist patients with Medicaid applications,… more
