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You will be responsible for providing plan members with personalized, coordinated health care that improves quality of life and prevents unnecessary hospital visits. We own nursing homes, health plans for Medicare beneficiaries living in long-term care facilities, as well as divisions offering psychiatric care, home health, hospice, rehabilitation and specialty pharmacy services.
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Health and life insurance, short-term disability and retirement plan. The group is passionate about preventative medicine, strongly recommending Medicare wellness exams, annual physicals, well-woman exams, immunizations and regular screenings for cancer, diabetes and heart disease.
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Responsible for overseeing and coordinating all clinical aspects of the health plan, including medical and pharmacy management, utilization review, and initiatives to ensure care and services provided align with evidence-based guidelines and best practices.
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Participates in conferences or teleconferences with the Clinical Director, Patient Care Manager, and/or home health clinicians regarding identified OASIS, utilization, or plan of care inconsistencies.
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If appointed you may be required to become an enrolled Medicare provider; obtain and provide to your employer a National Provider Identifier (NPI) number issued by the National Plan and Provider Enumeration System (NPPES); and otherwise actively participate to the degree necessary to allow for your services to be billed through Medicare and Medicaid.
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As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.
$20 - $30 an hourFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Three years recent Pharmacy Technician experience in a pharmacy that includes familiarity with pharmacy benefits, pharmacy claims, and working with difficult customers in person and via telephone; or three years Prior Authorization and pharmacy benefit experience at a pharmacy benefit company or health plan outside of HealthPartners/GHI.
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CommuniCare Advantage , a member of CommuniCare Health Services , is currently recruiting an experienced Sales Representative for our Medicare Advantage plan. Successful candidates will use a consultative sales approach to encourage enrollment in a Communicare Medicare plan by presenting product options to prospective members, while understanding and complying with Medicare regulations and company policies.
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Acts as an advisor and consultant in the establishment of operational policies of the practice to include: (1) Purchasing and capital allocations; (2) Managed care plan participation; (3) Budget and practice expenses; (4) Medicare/Medicaid participation; (5) Billing and collection of professional fees; (6) Personnel management and related policies; (7) Risk management and quality assurance; and (8) Coding compliance.
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With five hospitals, over 60 free-standing outpatient clinics, a college of nursing, a Medicare Advantage plan, and extensive outreach and community wellness programs, Mount Carmel Health System serves more than a million patients in central Ohio each year, and we've been a pillar of this community for more than 130 years.
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Communicate state plan amendments and negotiate with regional and national representatives from the Centers for Medicare and Medicaid Services (CMS) regarding coverage, provider qualifications, and reimbursement methodologies.
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One to one patient care in a home environment Execution of physicians prescribed plan of care and compliant documentation of care provided in system of record Administration of prescribed medication, treatments and therapies Patient assessments, coordination of care Health promotion, teaching, and training of family members.
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The strategic plan is changing the way we provide care and improving the health and experience of our patients; we are looking for smart, committed, compassionate people who want to be part of making our vision of better health and equity a reality.
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Five of Mission Hospital McDowell’s primary care practices have been recognized by the Centers for Medicare & Medicaid Services as Rural Health Clinics. Mission Hospital McDowell is a member of Mission Health, an operating division of HCA Healthcare.
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Identifies key policy issues and debates facing CVS Health’s Medicare Part D and other PBM business, collaborates with business leaders to understand business priorities; develops, recommends, and gains approval of CVS Health policy positions on these issues.
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