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Conditional Employment Requirements: Employment offers for this position will be contingent upon the results of a background verification and credentialing procedure consisting of: Michigan State Police clearance check, undergo and pass a Central Registry Screening, verification of a professional license, Medicaid/Medicare verification, verification of an acceptable driving record, educational background check and verification of an acceptable work history.
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Conditional Employment Requirements: Employment offers for this position will be contingent upon the results of a background verification and credentialing procedure consisting of: Michigan State Police clearance check, undergo & pass a Central Registry Screening, verification of a professional license, Medicaid/Medicare verification, verification of an acceptable driving record, educational background check and verification of an acceptable work history.
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Experience Medicare/Medicaid populations - MCG experience - Managed care experience - UM Certification - MedCompass - 1+ year(s) of inpatient utilization experience *Education. This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any state.
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Extensive experience in healthcare contracting, with a critical understanding of PBMs, National Health Plans, Medicare Part D/B, GPOs, VA/DoD, Medicaid, and the evolving market landscape.
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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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Michigan State Police clearance check, verification of professional license, Medicaid/Medicare verification, Board Certification, Controlled Substance license verification, National Practitioner Databank verification, educational background check and verification of an acceptable work history.
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Per Centers for Medicare & Medicaid Services (CMS) regulations, all McLaren employees must be vaccinated for COVID-19 by January 4, 2022. Performs surgical skin preps, basic skin care procedures, bedside finger stick blood sugars, and quality control checks of blood glucose instruments.
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Knowledge of terminally ill patients and their families along with understanding of hospice concept; knowledge of roles of all disciplines providing hospice services; excellent patient assessment skills; good oral and written communication; thorough knowledge of managed care principles, regulatory guidelines (i.e., Medicare, Medicaid, and human resource) management principles.
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Review the Medicare, Managed Care, Medicare Advantage and Medicaid UB, CHAMPS, WebDenis. + Process Medicaid applications. Review the Medicare, Managed Care, Medicare Advantage and Medicaid UB, CHAMPS, WebDenis.
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Plans and arranges for consultation needs of staff; prepares and maintains current policies and procedures which meet Medicare, Medicaid, accreditation standards, state and federal laws, etc.
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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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Assist the program director and the Central GME Office in monitoring and auditing the resident FTE's for purposes of governmental reimbursement from CMS (the Center for Medicare and Medicaid Services) for both the Direct and Indirect Medical Education funding of resident education.
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Awareness of NCQA requirements, CMS guidelines, Medicaid/Medicare contracts and benefit systems. 2+ years of clinical experience, primary care, home-based medical care, geriatrics or palliative care of emergency/urgent care.
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Advocacy - Leading voice with Administration officials to improve federal rules and regulations affecting Medicare, Medicaid, Duals, and CHIP. Work in close partnership with lobbying team to support congressional education and engagement, including federal lobbying activities on Capitol Hill, as well as with state officials focused on Medicaid solutions.
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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. Experience in Medicare/Medicaid products.
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medicare medicaid jobs in Okemos, MI
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