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Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. Presbyterian nurses have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.
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Collaborate / Facilitate with subject matter experts to author test strategies and use cases to exercise the Medicaid enterprise. Partner with Medicaid Enterprise module vendors and team leads to author cross-module test cases.
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Demonstrated knowledge of community resources, including social security, public assistance, and Medicaid systems. Clients Linked to Needed Community Services (OASAS Licensed Program Only) Assist clients in searching for safe affordable housing, legal services, selecting healthcare providers, and other essential community services.
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The new Magnet designation is in addition to several other prestigious recognitions which include: a five star rating from the Centers for Medicare and Medicaid Services (CMS), being named by IBM Watson Health as one the nation's highest performing hospitals, and among the top 10 Major Teaching Hospitals, an A for Patient Safety by The Leapfrog Group, the #1 hospital in the DC metro area by U.S. News & World Reports and being nationally ranked in gynecologic care.
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The McLaren system includes 13 hospitals in Michigan, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company.
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Research legal issues and provide expertise in the underlying l aws and regulations governing tax-qualified plans administered by WEX Health (e.g., FSAs, HRAs, HSAs, transit, wellness), including ERISA, HIPAA, the Internal Revenue Code, and Medicare/Medicaid regulations.
$146,000 - $194,000 a yearExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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4+ years of Customer Service Experience preferably in a social service, health insurance or Medicaid capacity. 2+ years of experience working directly with community-based programs specializing in the Medicaid market.
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Minimum Years of Experience: 7 yearsPreferred Qualifications: Degree Preferred: Master level degree (including MBA, MHA, MPH, MSW) Preferred Fields of Study: Health Administration, Business Administration/Management, Public Policy, Economics, Government Preferred Knowledge/Skills: Detailed understanding and/or experience of the inner workings of how federal or state agencies operate and govern Medicaid, Dual Eligible, or similar healthcare programs.
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Secures medical necessity checks/verification in accordance to Centers for Medicare & Medicaid services, verifies insurance, benefits, coverage & eligibility, completes assigned registration financial clearance work lists activities, obtains insurance authorizations for scheduled & unscheduled Hospital services, and secures inpatient visit notification to payors.
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Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: Value Based Payment, fee-for service, capitation and various forms of risk, ASO, etc.
Starting at $59,810.6 - $129,589.63 a year depends on education, experienceFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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Are knowledgeable about probate avoidance, asset protection, business formation, business succession planning, taxation, Medicaid-related issues and special needs planning. Knowledge in special needs, real estate, elder law, taxation, and asset protection would be advantageous.
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Job SummaryThe Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to member's with health care access or benefit coordination issues, ensuring that clinical grievances, complaints and complex issues are investigated and resolved to the member's satisfaction in a manner consistent with L.A. Care, Centers of Medicare and Medicaid Services (CMS) and regulatory guidelines.
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You will coordinate all external audits of Medicaid and Program Integrity-related activities such as reviews by the U.S. Department of Health and Human Services' Office of the Inspector General (OIG), Centers for Medicare & Medicaid Services (CMS), and the State Board of Accounts.
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These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company.
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