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  1. ) * Conducts periodic audits/reviews of established programs to determine efficiency, adherence to policy and effectiveness * Develop a...
    Marketplace User ·3 days ago on LocalHelpWanted
  2. * Identifies and refers potential and actual quality issues to quality management staff. * Keeps up-to-date with case management initiat...
    Marketplace User ·1 week ago on LocalHelpWanted
  3. The nurse will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and...
    Marketplace User ·1 week ago on LocalHelpWanted
  4. _**_** * **_**_Coordinates, tracks, notifies and assists members with EPSDT, immunization services and any special programs._**_** * **...
    Marketplace User ·1 week ago on LocalHelpWanted
  5. _**_** * **_**_Communicates with parents regarding EPSDT services. Notifies members when recommended preventive care services are due._*...
    Marketplace User ·1 week ago on LocalHelpWanted
  6. Responsible for development and implementation of compliance plan and coordination of fraud, waste and abuse (FWA) prevention, detection,...
    Marketplace User ·1 week ago on LocalHelpWanted
  7. Job Related Experience and Skills: * Full-time experience as an administrator in a Medicare or state-level Medicaid program, Health Main...
    Marketplace User ·1 week ago on LocalHelpWanted
  8. * Makes appropriate inquiries to determine potential coordination of benefits and advises appropriate provider and claims staff of same. ...
    Marketplace User ·1 week ago on LocalHelpWanted
  9. * Maintains updated department policies and procedures in compliance with state, federal and NCQA requirements. * Chairs Member Grievanc...
    Marketplace User ·1 week ago on LocalHelpWanted
  10. Under the supervision of the Supervisor, Facilities, the Receptionist position is part of a front desk team providing administrative supp...
    Marketplace User ·2 weeks ago on JobCentral
  11. This position is responsible for various planning and financially related projects. The duties include but are not limited to budgeting, ...
    Marketplace User ·2 weeks ago on JobCentral
  12. Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using cli...
    Marketplace User ·2 weeks ago on JobCentral
  13. Under the supervision of the Supervisor ICM, the Care Manager II assists members appropriate with appropriate care coordination and case ...
    Marketplace User ·3 weeks ago on JobCentral
  14. Coordinates system configuration changes, including tables, options, rules, and assessments and oversees system testing to make sure syst...
    Marketplace User ·2 weeks ago on LocalHelpWanted
  15. This position is responsible for managing the day-to-day activities of the Provider Network Operations department and staff. Responsible ...
    Marketplace User ·3 weeks ago on JobCentral
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