- 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)
- …work of external vendors. Assigns, directs, and monitors system analysis and program staff. These positions' primary focus is project/ program management, rather ... teams in planning and executing business programs. Assigns and monitors work of program management staff providing support and direction. + Serves as the subject… more
- Molina Healthcare (Roswell, NM)
- …and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits and overpayment ... and executing projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment… more
- Molina Healthcare (Roswell, NM)
- …governance framework and decision-making processes, as needed. + At the direction of program (CoE, Shared Service or other functional area) leadership, supports ... or a similar field). + Relevant work experience in healthcare compliance program operations and risk management;...experience. + Managed Care experience, preferably in a shared service , CoE or matrixed environment. + Experience with Microsoft… more
- Molina Healthcare (Roswell, NM)
- …Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified ... procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions. +… 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)
- …Duties** * Hires, trains, develops, and supervises a team of pharmacy service representatives supporting processes involved with Medicare Stars and Pharmacy quality ... and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. * Ensures that adequate staffing coverage is present at all… 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