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The Medicaid Waiver may be initiated prior to transferring the child to the children's unit. The Early Intervention Service Coordinator will have cases anywhere in the Sacramento area and will provide case management and advocacy for children from birth to three years of age with a developmental delay, established risk condition, or who are at high risk of having a developmental disability.
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This role requires in-depth knowledge of requirements for managed health care plans and value-based care including, but not limited to, the California Knox-Keene Act and Centers for Medicare & Medicaid Services (CMS) alternative payment models.
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Demonstrated understanding and knowledge of Medicaid, CMS, SMC/OBC, and MES. Deep Medicaid experience is critical, as well as experience working with the Centers for Medicare and Medicaid Services (CMS) and the new streamlined modular certification (SMC) and outcomes-based certification (OBC.
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Familiar with healthcare industry, including current trends, cultural concerns, and local/state/federal regulations, such as the CA Knox-Keene Act, California Insurance Code, Office of Inspector General (OIG) Work Plan, Affordable Care Act (ACA), and HIPAA regulations, in addition to federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal), Internal Revenue Code, Employee Retirement Income Security Act (ERISA), Americans with Disabilities Act, privacy and consent laws.
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5/+ years of experience working in health policy or health research, with a substantial portion of that time related to some aspect of the Medicaid program at the state or federal level. Apply rigorous analytic thinking to the collection and interpretation of quantitative and qualitative data, including analysis of Medicaid administrative data and site visits or telephone interviews with state and federal officials.
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Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists. Qualified candidates will have experience preferrably having worked in an inpatient hospital or LTC pharmacy setting, including both front and back end fulfillment experience, with 1-2 years of project managmenet experience a plus.
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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) through Hierarchical Condition Category (HCC) coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and support of Risk Adjustment Data Validation (RADV) audits.
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To conduct In-home Health Evaluations for Medicare Advantage, Medicaid, and certain commercial plan members. Paid Collaborative Physician Roles available in certain states. to conduct In-home Health Evaluations for Medicare Advantage, Medicaid, and certain commercial plan members.
Starting at $100 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Coordinates with other services provided under the Medi-Cal model, acting in collaboration with other partners and ensuring documentation reflects standards that meet or surpass Stanford Youth Solutions + Sierra Forever families, state and federal Medi-Cal/Medicaid standards.
$73,700 - $81,400 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Knowledge and experience with state and federal laws and regulations pertinent to managed care, particularly those promulgated by the Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), Department of Health Care Access and Information (HCAI), Covered California, and the Centers for Medicare & Medicaid Services (CMS.
$92,701 - $98,154 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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The IT Sup II supervises staff in addition to, but not limited to, the following positions mandated by the United States federal government Centers for Medicare and Medicaid Services (CMS): Automated Survey Processing Environment Automation Coordinator, Minimum Data Set Automation Coordinator, and Outcome and Assessment Information set Automation Coordinator.
$8,016 - $10,741 a monthFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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The Community Program Specialist II (CPS II) functions as a full journey person in monitoring, providing training and technical support to local programs implementing Medicaid funded programs, including but not limited to, the Home and Community-Based Services Waiver (HCBS), Self Determination Program Waiver (SDP), State Plan Amendments, Targeted Case Management, and other monitoring assignments.
$5,684 - $7,114 a monthFull-timeExpandApply NowActive JobUpdated 24 days ago - UpvoteDownvoteShare Job
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Conduct legal research and analysis related to provider reimbursement issues, Medicare and Medicaid appeals, audits, and internal investigations. The Regulatory Associate will primarily focus on provider reimbursement issues, Medicare and Medicaid appeals, and audits and internal investigations, supporting the firm's robust and sophisticated regulatory and reimbursement practices.
Full-timeRemoteExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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Knowledge with Centers for Medicare and Medicaid Services (CMS) Quality Programs, including the provider-based programs (Merit-based Incentive Payment System, MIPS Value Pathways, Alternative Payment Models, etc.
$79,600 - $99,500 a yearFull-timeRemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Experience with Medicaid, SSA, or other welfare programs specific to state and federal policies and procedures Preferred: 2 years' experience working with Business Objects. 5 years-experience working in a mainframe environment (with working knowledge of COBOL, VSAM file structures, JCL and TSO) Intermediate level experience with developing program specifications, pseudo code, or logic diagrams.
Full-timeExpandApply NowActive JobUpdated 4 days ago
medicaid job in California, CA
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