- Molina Healthcare (Roswell, NM)
- …SummaryProvides subject matter expertise and leadership to healthcare services function - providing support for project/ program /process design, execution, ... into functional requirements. * Conducts quality audits to assess healthcare services staff educational needs and service quality, and implements quality… more
- Molina Healthcare (Roswell, NM)
- **JOB DESCRIPTION** Job Summary: The AI Program Manager serves as a strategic leader driving the execution of AI initiatives to deliver meaningful business ... process improvement and organizational change management to operationalize the AI program vision. This includes end-to-end program planning (estimating,… more
- Molina Healthcare (Roswell, NM)
- …standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Manages team responsible for the ... appeals and denials. * Previous experience leading projects. * Strong customer service experience. * Strong organizational and time management skills; ability to… more
- Molina Healthcare (Roswell, NM)
- …member caseload for regular outreach and management. * Promotes integration of services for members including behavioral health, long-term services and supports ... Strong verbal and written communication skills. * Microsoft Office suite/applicable software program (s) proficiency. * In some states, a bachelor's degree in a… more
- Molina Healthcare (Roswell, NM)
- …supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program experience as needed ... Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified… more
- Genesis Healthcare (Roswell, NM)
- …**Opportunities!** **Recently Increased Wages** **Don't Forget To Ask About Our Referral Bonus Program !** At Powerback, we're on a mission to improve lives. As the ... and in school. With over 38 years of trusted service , our reach spans skilled nursing centers, assisted and...+ **Support for New Grads:** Our Powerback Clinical Mentorship Program kicks off on day one, helping you learn… more
- Molina Healthcare (Roswell, NM)
- **JOB DESCRIPTION** **Job Summary** Under direct supervision of the Manager , SIU, the Team Lead is responsible to lead a small team of investigators and provide ... daily investigative activities as a back-up to the SIU Manager . This position will be accountable for tracking on...policies and be able to apply them in ensuring program compliance via payment integrity programs. The position must… more
- Molina Healthcare (Roswell, NM)
- …Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) or Certified ... National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other standards and… more
- Molina Healthcare (Roswell, NM)
- …oversight and expertise related to behavioral health and chemical dependency services , and assists with implementation of integrated behavioral health care programs ... management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize… more
- Molina Healthcare (Roswell, NM)
- …medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for ... Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization management program… more
- Molina Healthcare (Roswell, NM)
- …oversight support. * Works with participating ancillary providers, public agencies or other service providers to make sure necessary services and equipment are ... all other settings. Strives to ensure that best possible services are available to members at time of hospital...Job Duties * Follows member throughout a 30 day program that starts at hospital admission and continues oversight… more
- Molina Healthcare (Roswell, NM)
- …QUALIFICATIONS:** + At least 6 years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting, ... and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits, Overpayment… more
- Walgreens (Roswell, NM)
- …to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient manner, and performs ... services as required; assists pharmacy staff in coordination of clinical services , Walgreens healthcare clinics and external providers. + Assists Pharmacy … more
- Walmart (Roswell, NM)
- …** It's time to see optometry through a new lens. Walmart is revolutionizing healthcare and this your chance to be part of it. A Walmart Associate Optometrist ... is the clinical partner to the Vision Center Manager , and core to our mission of advancing eyecare affordably for everyone. About The Optometry Team We're looking… more