Contribute policy expertise to state-level advocacy efforts on public payer issues including Medicaid expansion, integration of the Medicare and Medicaid programs, and state initiatives that affect the role of managed care in Medicaid programs.

Assist in the preparation and drafting of testimony, regulatory comments, and position statements sent to legislative and regulatory bodies and other interested parties concerning legislation, policies, published reports, regulations, and statutes governing Medicaid, long-term services and supports (LTSS), and other waiver programs.

EOHHS administers the Commonwealth’s Medicaid program, known as MassHealth. MassHealth is a cooperative state and federal program that provides health care benefits and premium assistance for uninsured families, disabled individuals, children, long-term unemployed adults, and seniors.

The San Francisco Regional Office provides legal services to almost all the regional components of HHS, including the Centers for Medicare and Medicaid Services, the Office for Civil Rights (OCR), and the Indian Health Service (IHS.

RN, care management, case management, UAS, ambulatory care, community health, Home health, LTSS, MLTC, medicaid, utilization management. The RN will be utilizing required NYS UAS Assessment Tools to determine functional status, medical, behavioral, psychological, and community resource needs for coordinating, integrating, and monitoring the use of medical and health care services for members; The SN UAS Nurse may also perform other technical and administrative tasks essential to the efficient operation of the department.

MFC is unique in that it involves protecting not only the Medicaid program of roughly $22.9 billion per annum, but also persons on Medicaid, and all residents of long-term care facilities.

Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services self-funded employee health benefit plan.

VNA Health Group is a premiere Medicare/Medicaid-certified provider of. We’ve been serving families and individuals with the most advanced and comprehensive clinical home care in NJ since 1912.

The LTSS/SAI National Senior Medical Director, reporting to a Regional CMO of Medicaid, will collaborate with Aetna National Medicaid, Regional and health plan leadership to identify, develop, implement, and evaluate the effectiveness of key LTSS strategic initiatives including trends, policies and programs, designed to drive the delivery of high value healthcare supporting a sustainable competitive business advantage for Aetna LTSS members.

Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers. Responsible for performing assessments on Medicare, Medicaid, Private Pay, Commercial insured and high-risk patients to determine discharge planning needs, always documents assessments.

You should have an understanding of regulations impacting digital products such as FCC (TCPA, CANSPAM), FTC, State Unfair Competition Laws; familiarity with EEOC/ADA/GINA, ERISA, HIPAA, Medicare/Medicaid a plus.

Serve as in-house counsel to an expanding comprehensive consumer healthcare company that meets people where they are in their personal journeys and connects them with both the information and the care they need.

We meet people where they are in their personal health journeys and connect them with both the information and the care they need. RVO Health was created by joining teams from both Red Ventures and UnitedHealth Group’s Optum Health.

This position is primarily responsible for adjudicating all medical and non-medical provider claims and submitting enrollments/disenrollment to Florida Medicaid and CMS. Position is key to PACE's revenue and expense process, procuring Medicare rate tables, processing provider claims for expenses by service line, ensuring client enrollment for accurate capitation reimbursement from Medicaid and Medicare, generating accruals for Accounting.

Keep up to date with the latest legal developments and changes in elder law, estate planning, and Medicaid rules. Assist clients in understanding and navigating Medicaid eligibility and application processes.