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Manipulates and extracts Medicare, Medicaid, and other healthcare claims data stored in Cloud environment using appropriate software such as SAS, Snowflake, Python, R, SQL, and other software as appropriate for the task.
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About the roleThe Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work with management to meet communicated single and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) , and be active and engaged in establishing Risk Adjustment processes.
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We CARE for our patients like they are our own FAMILY. Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), require COVID-19 vaccinations for all Medicare and Medicaid certified providers.
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VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Manhattan, New York. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 09/23/2024 Duration: Ongoing Employment Type: Staff Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health.
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Utilization Review in Medicare NOMNC/ABN Letters, Medicare Certifications, hospital referral review, evaluation of hospital records for ICD10 coding, setting of ARD dates, etc., of admissions and readmissions, OBRA scheduling, Part B Authorization as needed, CMI Picture Date.
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Coordinates, identifies, and/or initiates significant change MDS’ Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator Remains current with American Association of Nursing Assessment Coordinators (AANAC) requirements.
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Instruct patient and family members on proper use of equipment such as wheelchairs, braces, walkers, crutches, canes, and other prosthetic/orthotic devices Policies: Completes all clinical documentation following agency protocol and Medicare/Federal guidelines.
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Represent and serve as point person for the state health plan and Centene Corporation to outside trade groups/stakeholders including state AHIP organization, state medical association, state hospital association and related Medicare and Medicaid business vendors.
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The Audit and Reimbursement III will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services.
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Minimum of one year paralegal/legal assistant experience, preferably in healthcare environment or experience in Medicare or Medicaid provider enrollment or private payer enrollment/credentialing.
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Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 09/23/2024 Duration: Ongoing Employment Type: Staff Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health.
$93,000 a yearPart-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits.
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Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintain PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator.
$37 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Provides Medicare, Medicaid (case mix), and managed care oversight to ensure appropriate clinical services are provided and appropriate reimbursement is received for each resident. QUALIFICATIONS & EXPERIENCE REQUIREMENTSGraduate of an accredited school of nursing; RNValid RN license in the state employedThree years of experience in a long term care environment preferredExperience with the MDS/RAI process and/or case management preferred JOB RESPONSIBILITIESThe MDS Nurse RAC (Resident Assessment Coordinator) reports to the Executive Director and is responsible for accurate and timely completion of mds assessments and coordination of the RAI process.
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Works collaboratively with the Utilization Management team, Denial Manager, Physician Advisor, Physician staff, Nursing staff, Case Management, Finance, Clerical Support staff and payer liaisons.
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medicare medicaid utilization management jobs Title: support coordinator
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