- Molina Healthcare (Long Beach, CA)
- Job Description JOB DESCRIPTION Job Summary Molina Pharmacy Services/ Management staff work to ensure that Molina members, providers, and pharmacies have access to ... laws. Jobs in this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization… more
- Actalent (Fort Lauderdale, FL)
- …review Utilization management InterQual Milliman Commercial Guidelines Medicaid Medical management Medicare Managed care Patient care Medical record Case ... Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management...and Milliman Criteria. Knowledge of Florida Medicaid Program and CMS Guidelines. Proficient in word processing software, spreadsheet software… more
- Pearl Health (New York, NY)
- …intelligence, and making care delivery more efficient and sustainable. The Center for Medicare and Medicaid ( CMS ) is launching a new value-based care program ... years of clinical experience in a healthcare setting in chronic care management , preferably for Medicare beneficiaries. Insurance experience preferred. Strong… more
- Athena Health Care Systems (Marlborough, MA)
- … program agreement. Issues and delivers Medicare denial letters per CMS regulations. Assures appropriate management of residents' Medicare /Insurance ... denial notices timely and appropriately. Complete and transmit all CMS approved item sets (MDS) Must be knowledgeable of...sets (MDS) Must be knowledgeable of and follow current CMS regulatory guidelines as described in RAI Manual. Complies… more
- American Recruiting and Consulting Group (Jacksonville, FL)
- …Administrative Contract (MAC). This role serves as a liaison between the Centers for Medicare and Medicaid Services ( CMS ) and stakeholders. CMDs play a vital ... problem areas. Collaboration and Leadership 30% * Collaborate with CMS and other Medicare Contractors (eg, A/B...three years PREFERRED QUALIFICATIONS * MBA, MHA, MS in Management , or formal accredited coursework in medical systems … more
- BAYADA Home Health Care (Sterling, VA)
- …home health agency preferred but not required Comprehensive knowledge of Medicare regulations, OASIS documentation, HIPAA, and CMS guidelines. Proficiency ... experienced and compassionate Director to manage operations at our Falls Church, VA Medicare -certified Home Health office . The ideal candidate will have a strong… more
- AdventHealth (Louisville, CO)
- … department, including but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services ( CMS ) Conditions of Participation, Discharge Planning, ... HEALTH PARK DR, Louisville, 80027 The role you'll contribute: The Care Management Facility Director has full accountability and oversight for the overall operations… more
- Advocate Aurora Health (Park Ridge, IL)
- …budgets and controls expenditure within approved budget objectives. Ensures the care management /social work program operates within compliance of CMS , OSHA, ... Department: 11224 Advocate Aurora Health Corporate - IL Inpatient Care Management Operations Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule… more
- SKLD (Bloomfield Hills, MI)
- …all OBRA tracking forms and assessments are scheduled per RAI guidelines. *Review Medicare A (Managed Care if utilizing PDPM) admissions to assure that the necessary ... plan of care. *Assign primary ICD-10 code for all Medicare A and Managed Care residents that are utilizing...Care MDS assessments that are required for reimbursement per CMS and managed care guidelines. *Collaborate with NAC team… more
- Advocate Aurora Health (Kenosha, WI)
- Department: 11200 AMC Kenosha - Case Management Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Monday - Friday ... for patient, family, and staff when patients are transferred. Provides case management services related to various levels of health care, finances, housing, family… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to ensure that all Commercial (Pharmacy and Medical benefits) and Medicare Advantage Part D coverage determination requests are processed consistently, timely ... and accurately in accordance with UM guidelines and are compliant with NCQA and CMS guidelines. In this role, you will manage a clinical staff in a call center… more
- Zenex Partners (San Francisco, CA)
- …includes MS-DRG classification according to regulatory compliance set forth by Centers for Medicare and Medicaid Services ( CMS ). This process will be applied to ... review, interaction with physicians, allied health professionals, health information management professionals, and nursing staff. The CDS assists the organization… more
- University of Maryland Medical System (La Plata, MD)
- …Regional? Commitment to Excellence - Recognized as a 4-star hospital by the Centers for Medicare and Medicaid Services ( CMS ) and honored with the Get With The ... Regional Medical Center, a proud member of the University of Maryland Medical System , where we combine the resources of a top-tier healthcare network with the… more
- Memorial Health (Marysville, OH)
- …providers and managers, to obtain billing and coding information. Accounts Receivable Management : Manages account review and processing from system WQs, insures ... using the Release of Information (ROI) module in Health Information System (HIS). Verifies and updates patient account demographic and financial information,… more
- Stamford Health (Darien, CT)
- …Report has recognized Stamford Hospital as a High-Performing Hospital. The Centers for Medicare and Medicaid Services ( CMS ) rated Stamford Hospital as a ... anticipated time of service. Scheduling Schedules patient exams as relevant system /scheduling software, including all walk-ins. Makes outbound patient calls to help… more
- Healogics (Henderson, NV)
- …accrediting organizations, federal and state regulation, and to the Centers for Medicare and Medicaid Services ( CMS ) guidelines, as applicable. Essential ... interpersonal and communication skills, both orally and in writing Organization and time- management skills Ability to type 60 words per minute (wpm) Basic math… more
- Denver Health (Denver, CO)
- …record. Must participate in continuous education on ICD-10, clinical medicine, Center of Medicare and Medicaid ( CMS ) and other billing carriers, as well as ... the following medical documentation related function: clinical coding, case management , DRG coordination, physician education, Medicaid/ Medicare reimbursement.… more
- BioTAB Healthcare (Tampa, FL)
- …not limited to: CMS and OFCCP guidelines related to our Quality Management System , documentation and process creation and training. Strong communication and ... all insurance payers: including the criteria to qualify patients under CMS guidelines, understand private payer copays, deductibles, and the required documentation.… more
- San Ysidro Health (Vista, CA)
- …in printing, proofing, and inventory control. Ensures compliance with all applicable CMS (Centers for Medicare & Medicaid Services) and California Department ... Marketing Coordinator is responsible for some aspects of planning, development and management of the PACE (Program of All-Inclusive Care for the Elderly) marketing… more
- Tanner Health System (Carrollton, GA)
- …with standards set forth by regulatory agencies, to include the Centers for Medicare and Medicaid Services ( CMS ). Attend meetings and participate in continuing ... current knowledge of roles and responsibilities as they relate to Emergency Management . Function appropriately in the Incident Command System during disasters… more
