- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the CMHS. ... is appropriate to meet TRICARE beneficiaries' healthcare needs. + Gather information , identify, and analyze data, and develop recommendations to resolve problems… more
- DESC (Seattle, WA)
- …**Data, Quality Improvement & Compliance** + Partner with DESC's Quality & Information Management team to ensure accurate data collection, reporting, and ... a key operations-focused leadership role ensuring that staff, supplies, data systems , workflows, and partnerships are in place to support high-quality, low-barrier… more
- Commonwealth Care Alliance (Boston, MA)
- …Knowledge, Skills, Abilities & Language (nice to have): - Familiarity with care management and utilization management systems and workflows. - Experience ... delegated partnerships programs, working with clinical community partners responsible for care management and utilization management across CCA's One Care and… more
- DESC (Seattle, WA)
- …(ABD), Social Security Income (SSI), Social Security Disability (SSDI), Apple Health Medicaid , Medicare, and ORCA Lift. A strong applicant will be familiar with ... includes (but is not limited to) ABD, SSI, SSDI, Medicaid , Medicare, and ORCA Lift. + Work with STAR...benefits-related issues, such as contacting an agency, updating personal information , or connecting them with specialists for more in-depth… more
- Stanford Health Care (Palo Alto, CA)
- …summarizing data, presenting results + Ability to comply with the American Health Information Management Associate's Code of Ethic and Standards and applicable ... workflows and CDM + Knowledge of DRG/APC reimbursement + Knowledge of health information systems for computer application to medical records + Knowledge of… more
- Wisconsin Community Services (Waukesha, WI)
- …program participants by providing assessment, treatment planning, assertive case management , symptom management , medication monitoring, crisis-intervention, and ... and hands on assistance in the areas of housing, money management , vocational/educational pursuits, scheduling and transportation for appointments. * Encourage and… more
- Commonwealth Care Alliance (Boston, MA)
- …engagement strategies aligned with network performance goals. - Familiarity with CRM systems (eg, Salesforce) and provider relationship management tools. - ... engagement, delegation partnerships, provider services, contracting, quality, compliance, medical management , and analytics teams to advance provider network operations,… more
- COOLSOFT (Lincoln, NE)
- …and non-production environments. Required Qualifications Bachelors degree in Computer Science, Information Systems , or a related field (or equivalent experience) ... with cloud-based environments, and a solid understanding of healthcare or Medicaid data. Key Responsibilities DB2 Warehouse Administration & Operations Install,… more
- Commonwealth Care Alliance (Boston, MA)
- …does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management - Serve as the primary relationship manager and point of contact ... - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal teams as needed.… more
- Stanford Health Care (Palo Alto, CA)
- …reports -Financial disclosures to the Department of Health Care Access and Information (HCAI) In addition, the Director of Reimbursement oversees the organization's ... actively contributes to process improvement initiatives, drives innovation in financial systems , and fosters a culture of change, accountability, and continuous… more
- Commonwealth Care Alliance (Boston, MA)
- …on CCA's Population Health goals; including Medicare Star measures, Medicaid -Medicare Plan withhold measures, quality performance metrics incorporated into other ... and Linguistically Appropriate Services, Consumer Assessment of Healthcare Providers and Systems (CAHPS), and social determinants of health (SDOH) measures. The… more
- Organon & Co. (Plymouth Meeting, PA)
- …complex contract language and strategies. + Advanced proficiency in contract management systems , document repositories, MS Excel, and reporting tools. ... would support development into other areas of Market Access & Account Management . **Responsibilities** Contract Management , Compliance & Risk Management ,… more
- Katmai (Usaf Academy, CO)
- …+ Demonstrates knowledge, skill, and ability to use basic office automation and information management equipment and programs (ie, word processing, database ... with military and civilian healthcare providers and staff and uses Utilization Management (UM) systems support to identify high-risk/high-cost patients within… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …for further handling + Perform data entry of authorization details into systems and communicate relevant information to the originating physician, facility, ... Assist with complaints and appeals related to eligibility and claims, documenting information accurately in the utilization management system _Provider and… more
- Stanford Health Care (Palo Alto, CA)
- …the ICD-10-CM Official Guidelines for Coding and Reporting, the American Health Information Management Association (AHIMA) Code of Ethics and Standards of ... deadlines + Ability to comply with the American Health Information Management Association's Code of Ethics and...Knowledge of APC grouping methodology + Knowledge of health information systems for medical records (Epic and… more
- Moses/Weitzman Health System (Middletown, CT)
- …+ One of the following must be met: 1) Associates degree in Health Information Management Systems (or related field) with 1+ years' experience ... load to achieve a high level of productivity + Notifies Manager of information that negatively impacts production + Assist with special projects as needed… more
- General Dynamics Information Technology (Fairfax, VA)
- …healthcare solutions. Our team is dedicated to improving the efficiency and effectiveness of Medicaid Management Information Systems (MMIS). We are ... will be responsible for the implementation, maintenance, and optimization of Medicaid Management Information Systems (MMIS). This role involves… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Medicaid Management Information Systems (MMIS) Supervisor** **Job Class: Systems Supervisor** **Agency: Minnesota IT Services** + ... illness, chemical dependencies, and physical or developmental disabilities. As the Medicaid Management Information Systems Supervisor, you will supervise… more
- PruittHealth (Norcross, GA)
- …data system 8. Verify Medicaid eligibility or continued eligibility via the Georgia Medicaid Management Information Systems (MMIS) 9. Maintains ... Waiver Program (EDWP) clients who do not have active Medicaid eligibility [Potential Medicaid Assistance Only (PMAO)...and census data. 2. Coordinates with Home First Case Management agencies in determining EDWP clients' MAO or PMAO… more
- General Dynamics Information Technology (Menands, NY)
- …skills + Preferred Qualifications: + Prior experience as a Business Analyst for Medicaid Management Information Systems in Design, Development, ... the mission of New York State Department of Heath Medicaid Management Information System (MMIS)...must have: + Education: Bachelor's degree or equivalent in Management Information Systems , or a… more
