- Mindlance (Nashville, TN)
- …Type: Contract Position Summary: We are seeking a detail-oriented and compliance-focused Medicare Marketing Material Reviewer to support the review and tracking ... and MultiPlan standards before approval and distribution. Key Responsibilities: *Receive, review , log, and track Medicare marketing materials submitted by… more
- Optum (Delano, MN)
- …have strong analytical, critical thinking and organizational skills Knowledge of Utilization Review , Medicare Requirements processes as well as State and Federal ... state regulations. Shows working knowledge of managed care and Medicare health plans and reimbursement related to post-acute services...regulations pertaining to Utilization Review and Discharge Planning The salary range for this… more
- Humana, Inc. (Chester, PA)
- …our caring community and help us put health first Are you passionate about the Medicare population, looking for an opportunity to work in sales with the ability to ... as well as, visiting prospects in their homes. Our Medicare Sales Field Agents sell individual health plan products...protection. Please be aware that applicants selected for leader review may be asked to provide their social security… more
- Windsor Healthcare (Oakland, CA)
- …and progress achieved to date. Includes specific, objective measurable goals. Managing Medicare Medical Review and Denials process in conjunction with Director ... to the rehab team conferences, patient care conferences, utilization review meetings, family conferences, and caregiver training sessions. Collaborating with… more
- National Recruiters (Mankato, MN)
- …physicians included What you'll do: Complete comprehensive in-home HRAs for Medicare Advantage patients Review each patient's medical history, current ... in a flexible PRN role conducting in-home Health Risk Assessments (HRAs) for Medicare Advantage members. This is a great way to supplement your income, work… more
- Molina Healthcare (Long Beach, CA)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... and measuring performance metrics regarding patient outcomes, medications safety and medication use policies). KNOWLEDGE/SKILLS/ABILITIES Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State… more
- CarepathRx (Oakdale, PA)
- …infusion therapy for admissions in accordance with company policies, CME Medicare guidelines, CMS HIT, ACHC standards and insurance requirements for authorizations. ... home safety. Qualify patients for home infusion therapy bases on CMS Medicare guidelines, CMS HIT, insurance requirement for authorizations, compile all supporting… more
- Strategic Staffing Solutions (Detroit, MI)
- …strong foundation in medical terminology, medical coding and billing, CMS Medicare regulations, and clinical practices are necessary. *Health Insurance experience: ... Must have Medicare Advantage experience working for a health insurance provider....formatting, and document styling, to facilitate submission and publication. * Review and revise draft documents for content accuracy, clarity,… more
- UofL Health (Louisville, KY)
- …and every patient each and every day. Job Description: We are Hiring Utilization Review RNs at Peace Hospital Location: 2020 Newburg Rd Louisville KY Shift: First ... we serve through compassionate, innovative, patient-centered care. The Utilization Review RN performs activities which support the Utilization Management functions.… more
- Qlarant (Atlanta, GA)
- …programs. We have multiple lines of business including population health, utilization review , managed care organization quality review , and quality assurance for ... receiving services and provider staff in a respectful manner. Documents accurate review findings and generates reports based on the results Required Skills To… more
- Baptist Health Care (Gulf Breeze, FL)
- Job Description The Utilization Review Nurse acts as a patient and organizational advocate. An autonomous role that coordinates, negotiates, procures services and ... cost while ensuring the highest quality of care is maintained. Applies review criteria to determine medical necessity for admission and continued stay. Provides… more
- Office of the Secretary of Health and Human Services (Phoenix, AZ)
- Summary The Office of Medicare Hearings and Appeals (OMHA) administers the third level of appeals nationwide for the Medicare program, ensuring that ... priority over other applicants. Clarification from the agency Current Office of Medicare Hearings and Appeals (OMHA) federal employees serving under a competitive… more
- Orlando Health (Ocoee, FL)
- …with review requirements for Managed Care contracts, governmental payors (ie Medicare , Medicaid, and Champus) and departmental review policies; adheres to ... Utilization Management Plan. *Communicates in an appropriate and timely manner with interdisciplinary team to coordinate/evaluate plan of care. *Communicates with third party payers and external care team as appropriate/necessary. *Monitors and evaluates data,… more
- TriHealth (Cincinnati, OH)
- …in Norwood Ohio. Program of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their health care needs in the ... contracts into required systems/vendors, and managing the provider manual; Lead all Medicare Part D operations, including managing PBM and pharmacy services vendors;… more
- PACS (El Cajon, CA)
- …the care plan as according to regulatory requirements. Create the schedule for all Medicare and Medicaid. They also start Medicare coverage for newly qualified ... patients or send out denial letters. They remain updated on changes in Medicare coverage and help determine documents needed for Medicaid reimbursement. Direct the… more
- CCG Business Solutions, LLC (Washington, DC)
- …hospitalization, and accident insurance Voluntary ID theft protection Voluntary pet insurance Medicare consulting Firm-paid CLE, bar review fees, and bar dues ... Our team understands the principles of connecting purpose to business and career placement. The Talent Management Division is currently seeking a Fintech & Financial Services Associate - Securities Law. Job Description CCG is excited to offer the opportunity… more
- South Orange County Community College District (Mission Viejo, CA)
- …Meet workload obligations. Maintain accurate records. May participate in curriculum review and program development. Assignments may include day, evening, weekend, ... of eligible retirees, shall continue until the retiree reaches the age of Medicare eligibility. The retiree may be eligible for continued benefits after reaching the… more
- Optum (San Antonio, TX)
- …years of experience in a customer service setting 6+ months of experience with Medicare Part D, particularly the pharmacy record review , claims, billing and ... record with accurate information obtained on the call Performs desk and on-site review of all claims documentation to validate correct billing and that payment made… more
- Insperity (Chatsworth, CA)
- …and timely adjudication of CMS 1500 and UB-04 claims, ensuring compliance with Medicare and Medi-Cal guidelines. At Thrifty, we pride ourselves on our people-first ... an HMO environment (ie, MSO, IPA, or health plan) Solid knowledge of Medicare and Medi-Cal managed care claims processing and compliance guidelines. Experience with… more
- Inland Empire Utilities Agency (Chino, CA)
- …up to $3,000 This position is open until filled. The deadline for the first review of applications is 11:59 PM on Tuesday, April 29, 2025. Applicants that submit ... applications after the first review deadline are not guaranteed to be considered for...7% of eligible earnings toward the employee contribution. Social Security/ Medicare : Along with CalPERS retirement, the Agency also participates… more
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