- CVS Health (Austin, TX)
- …we do it all with heart, each and every day. **Position Summary** As an RPh Advisor you will be directly supporting Medicare Part D members and providers with ... information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a… more
- LA Care Health Plan (Los Angeles, CA)
- …The Compliance Advisor III ensures that the Plan's processes and operations are compliant with all state and federal regulatory requirements, including but not ... Compliance Advisor III Job Category: Administrative, HR, Business Professionals...limited to, the Centers for Medicare and Medicaid Services (CMS), the California Department of… more
- LA Care Health Plan (Los Angeles, CA)
- Compliance Advisor II Job Category: Administrative, HR, Business Professionals Department: Compliance Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... required to achieve that purpose. Job Summary The Compliance Advisor II ensures LA Care business units are compliant...of the Compliance Department and to support the business operations of LA Care Health Plan. Duties Analyze and… more
- Elevance Health (Walnut Creek, CA)
- …quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations . May identify cost of care ... **Medical Director- Medicare and Medicaid** Location: This role enables associates...will be responsible for utilization review case management for Medicare and Medicaid in the California market while also… more
- Ochsner Health (New Orleans, LA)
- …difference at Ochsner Health and discover your future today!** The Physician Advisor (PA-Utilization Management) serves as the physician leader in matters relating ... of Quality Assurance and Utilization Review Physicians (ABQAURP) or (3) Physician Advisor Sub-Specialty Certification by the American Board of Quality Assurance and… more
- US Tech Solutions (May, OK)
- …for this position. **Skills:** + MUST HAVE MANAGED CARE exp and Medicare /Medicaid knowledge. + MUST HAVE 6 months of experienced with Prior Authorization(required). ... + MUST HAVE experience with Medicare Part D + Must Have Pharmacy Benefit Management (PBM) experience. **Education:** + Pharm D. required with at least two years… more
- TEKsystems (Minneapolis, MN)
- Licensed Benefit Advisor 100% Remote - Equipment Provided Anticipated Start Date: August 4th 2025 Pay: $21/hr + Commission MUST be current resident of state licensed ... Health Insurance License (240) Description The Licensed Virtual Benefit Advisor 's responsibilities include selling and enrolling retirees into appropriate insurance… more
- Humana (Honolulu, HI)
- …caring community and help us put health first** The Strategy Advancement Advisor provides data-based strategic direction to identify and address business issues and ... support for business segments or the company at large. The Strategy Advancement Advisor works on problems of diverse scope and complexity ranging from moderate to… more
- WellSpan Health (York, PA)
- …for Population Health Strategies including ACO development, WellSpan Provider Network operations , Medical Home/ Neighborhood development and the Bridges to Health ... Assist with Bridges to Health referrals and cases as needed. + Provides Physician Advisor support to all WellSpan entities as needed and at the direction of the… more
- The Cigna Group (St. Louis, MO)
- …the build of those with peer technical teams.** The Business Analytics Advisor should be familiar with data analysis, process improvement, innovative test & ... defects with the appropriate technology teams along with keeping the voice of Operations at the forefront of all decisions.** + Directly guiding delivery and… more
- AdventHealth (Orlando, FL)
- …in the medical community and a corporate environment Payor experience in operations **EDUCATION REQUIRED** **:** + Graduate from medical school and residency program ... practice experience **_Experience Preferred_** _:_ . Understanding of hospital Utilization Management/ Medicare Regulations . Two years or greater experience as a… more
- Hackensack Meridian Health (Neptune City, NJ)
- …adherence to intake process for each referral from start to hand off to operations for scheduling. Meet productivity standards on a daily basis. Maintain an accurate ... off to F2F team with appropriate information. + Knowledgeable in current Medicare reimbursement criteria and insurance contracts for the organization product lines.… more
- The Cigna Group (Denver, CO)
- …regular meetings with teams within the Adoption Center as well as technology and operations teams to ensure issues are being identified, tracked, and acted upon by ... with Microsoft Office Suite **Preferred Qualifications** : + Knowledge of Medicare and/or Commercial Network, Contract and Demographic provider data elements highly… more
- Northwell Health (Westbury, NY)
- …viability of Northwell Health by effectively managing the organization's revenue capture operations . The Director works in close partnership with many aspects of the ... policies and procedures to improve the efficiency of current systems/ operations /processes/functions. + Evaluates, develops, and implements quality management and… more
- MetroLink (Los Angeles, CA)
- …Services Department. This individual will be a thought leader, trusted partner, and advisor to multiple executives and their departments. The Deputy CTO will also be ... level understanding of business theory, business processes, management, and business operations . + Principles and practices in the planning, designing, and managing… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Physician Advisor Operations Coordinator, Revenue Integrity and Utilization PRN/OCC, Variable Hours, Day Shift Covenant Health Overview: Covenant Health ... named a Forbes "Best Employer" seven times. Position Summary: The Physician Advisor Operations Coordinator will perform activities to help facilitate utilization… more
- Saratoga Hospital (Saratoga Springs, NY)
- …Medical Home/ Health Home based on risk status. Responsible for daily operations to coordinate high quality cost effective care at Saratoga Hospital. ... status and level of care. As needed consults internal and external physician advisor for 2nd level reviews. 4. Initiates community resource referrals as needed based… more
- Houston Methodist (The Woodlands, TX)
- …by analyzing clinical protocols. + Escalates appropriate cases to the Physician Advisor (or services) for appropriate second level review, peer-peer discussions, and ... payer denial- appeal needs. Consults with physician advisor as necessary to resolve progression-of-care barriers through appropriate administrative and medical… more
- Option Care Health (Phoenix, AZ)
- …program. The Vice President provides expert guidance on strategic initiatives, day-to-day operations , and leads the monitoring and assessment of changes in the ... (listed in order of importance and/or time** **spent)** Act as a trusted advisor to our business teams providing strategic guidance and support on compliance-related… more
- New York State Civil Service (Brooklyn, NY)
- …at Treatment Team meetings, as well as assist in patient care and facility operations . * Serve as a health advisor to a multi-disciplinary team.* Participate ... in activities intended to improve patient care and facility operations . * Proficient use of a computer is required for record keeping and documentation. * Other… more