- Molina Healthcare (Bowling Green, KY)
- …improve our member and provider experiences. **KNOWLEDGE/SKILLS/ABILITIES** + Manages member services operations. + Ensures compliance with state and ... **JOB DESCRIPTION** **Job Summary** Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and… more
- Molina Healthcare (Bowling Green, KY)
- …+ Participate in Member engagement work groups as needed to ensure Medicare member needs are being anticipated and addressed. + Participates in regular ... and manager . Basic understanding of managed healthcare systems and Medicare . **PREFERRED EDUCATION:** Associate's or Bachelor's Degree in Social Work, Human … more
- Cognizant (Nashville, TN)
- ** Service Delivery Manager ** **Hybrid - Winston Salem, NC** **Overview:** Our Cognizant leadership team working with Clients is currently seeking Ops manager ... highly motivated leaders with a Healthcare background who managed Member / Provider call centers previously with a team...have expertise in MS Excel and a background in Medicare Enrollment Healthcare Call Center and IVR is a… more
- Humana (Nashville, TN)
- …drive improved health outcomes for our dual members - members that qualify for both Medicare and Medicaid. The Lead Product Manager sits in the center of ... first** We are looking for a dynamic Lead Product Manager to develop clinical solutions for our members and...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel,… more
- HCA Healthcare (Hermitage, TN)
- …cares about every stage in your career! We are interviewing candidates for our Case Manager RN opening. **Apply today and a member of our Talent Acquisition team ... any other healthcare provider. We are seeking a(an) Case Manager RN to join our healthcare family. **Benefits** TriStar...include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay.… more
- Humana (Nashville, TN)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... are building and maintaining a cloud platform that spans multiple cloud service providers (CSPs) to deliver scalable, secure, and high-performance solutions. As we… more
- Kestra Medical Technologies, Inc (Nashville, TN)
- …In addition to direct sales responsibilities for a given territory, the Territory Manager provides training, on-going product service and support, and assistance ... Team Member regardless of geography, position, and product or service . * Action/Results: High energy, decisive planning, timely execution. * Innovation:… more
- Humana (Nashville, TN)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... receive interim approval for government security clearance (NBIS - National Background Investigation Services ) + HGB is not authorized to do work in Puerto Rico per… more
- Molina Healthcare (Bowling Green, KY)
- …annually or as directed by the Centers for Medicare and Medicaid Services . * Trains grievance and appeals staff, customer/ member services department, ... Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and communicating resolution to members or authorized representatives in… more
- Elevance Health (Nashville, TN)
- …integration, and ensures essential face-to-face onboarding and skill development. **National Government Services ** is a proud member of Elevance Health's family ... Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal...independently on assignments and under minimal guidance from the manager . + Prepare detailed work papers and present findings… more
- Signature Healthcare (Westmoreland, TN)
- …facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services . Additionally, we have been awarded as a certified ... empowerment, we earn the trust of every patient, family member , and the community we serve. Signature HealthCARE is...HealthCARE is a family-based healthcare company that offers integrated services in 7 states across the continuum of care:… more
- Elevance Health (Nashville, TN)
- …integration, and ensures essential face-to-face onboarding and skill development. **National Government Services ** is a proud member of Elevance Health's family ... Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Option Care Health (Nashville, TN)
- …Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team members including 5,000 ... licensed professional who provides direct and indirect patient care services under a physician's plan of care and in...direct patient care 20-40% of the time. In a Medicare Certified Home Health agency, this position may also… more
- Evolent (Nashville, TN)
- …Business Manager . + Provides medical direction to the support services review process. Responsible for the quality of utilization review determinations, ... Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),...Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Elevance Health (Nashville, TN)
- Wellpoint, formerly Amerigroup, is a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide ... administrative services to Medicaid plans in partnership with blue cross...Tennessee, positively impacting the affordability of respective Medicaid and Medicare Advantage health plan products. + Develops new provider… more
- Cardinal Health (Nashville, TN)
- …better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions-driving brand and patient markers of ... fully integrates direct drug distribution to site-of-care with non-commercial pharmacy services , patient access support and financial programs, Sonexus Health, a… more
- CenterWell (Nashville, TN)
- …of senior-focused primary care, one of the largest providers of home health services , and fourth largest pharmacy benefit manager , CenterWell is focused on ... clinical efficiencies, processes, education, and compliance as it relates to Medicare Risk Adjustment. Uses data-based insight to direct process improvement efforts… more
- Molina Healthcare (Bowling Green, KY)
- …and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. + Applies appropriate ... denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and reports quality of care… more
- CenterWell (Madison, TN)
- …of senior-focused primary care, one of the largest providers of home health services , and fourth largest pharmacy benefit manager , CenterWell is focused on ... for the development, implementation and management oversight of the company's Medicare /Medicaid Stars Program. The Quality RN Professional work assignments are… more