- Option Care Health (Bannockburn, IL)
- …and abuse, including but not limited to HIPAA, Anti-Kickback, Stark, Medicare /Medicaid reimbursement. Experience evaluating information to determine compliance ... patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …organization expert on CMS regulatory changes and will make recommendations to senior management related to proposed changes. Takes the lead for the organization's ... to research complex coding, reimbursement and regulatory requirementsKnowledge of clinical settings such as Laboratory, Radiology, Physical or Occupational Therapy,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …we need: As an integral part of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as ... escalate to senior leaders for decision making + Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity… more
- The Cigna Group (Miramar, FL)
- …organization (which includes Market Provider Performance, Sales, Health Services, Clinical , Stars & Risk Adjustment, Finance, Marketing, Cross-Segment Contracting, ... and Network Development & Solutions). Reporting to the Provider Performance Senior Manager/Operations Director/Operations Senior Director (Market President), the… more
- CVS Health (Fresno, CA)
- …report and recommend solutions. Independently coaches others on appeals ensuring compliance with Federal and/or State regulations. Manage control and trend ... the appeal if there is an inquiry from leadership, compliance and State regulators. Understand and adapt to departmental...regulators. Understand and adapt to departmental process and policies. Medicare knowledge is a plus. Fast Turn Around of… more
- BrightSpring Health Services (Arlington, TX)
- …focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacyenvironment. Our organization is inhigh ... calls/claims per hour as determined by the Director and Clinical Hub Manager + Provide clinical support...Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and State Laws, and applicable… more
- CareOregon (Portland, OR)
- …Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Senior Clinical Pharmacist Exemption Status Exempt Department Pharmacy Manager ... inclusion when framing thoughts and ideas. Job Summary The Senior Pharmacy Clinical Coordinator is responsible for...clinical or quality initiatives for both Medicaid and Medicare . + Coordinate with the contracting department on clinic… more
- University of Maryland, Baltimore (Baltimore, MD)
- *The University of Maryland Baltimore has an exciting opportunity**for a Senior Clinical and Corporate Resource & Budget Management Associate (CCT Admin Budget ... **Reg or CII Exempt Staff* **Organization:** **Research and Development - Center for Clinical Trials* **Title:** * Senior Clinical & Corporate Contracts… more
- University of Maryland, Baltimore (Baltimore, MD)
- *The University of Maryland, Baltimore (UMB) is seeking a Senior Associate, Clinical Trials & Corporate Contracts (CCT Contract Admin II). *This position ... clinical and/or corporate contracts and collaboration agreements in compliance with sponsor, federal, state and university policies and regulations. *… more
- AdventHealth (Maitland, FL)
- …32751 **The role you'll contribute:** The Population Health Services Organization (PHSO) Senior Manager of Clinical Documentation Integrity (CDI) will be ... Medical Record tools, Communication protocols, and Quality Assurance (QA) and compliance programs to effectively meet targeted engagement, clinical and… more
- Ellis Medicine (Schenectady, NY)
- The Clinical Resource Coordinator functions as the clinical nurse manager and oversight Ellis Medical Group Outpatient Practice location(s) (as assigned). ... care delivery to ensure efficient and effective patient care. Responsible for compliance with departmental and regulatory standards of care and practice. In… more
- Kestra Medical Technologies, Inc (Kirkland, WA)
- …this role, you will have responsibility for managing all aspects of Kestra sponsored clinical trials for the generation of clinical evidence for the ASSURE ... + Manage all aspects of the ASSURE Patient Registry study including clinical data management, analysis, reporting and abstract/manuscript preparation + Design, plan… more
- PruittHealth (Atlanta, GA)
- …are appropriate for admission to the home health or hospice agency. Provides clinical expertise to our home health and hospice agencies by evaluating their ability ... to meet the patient's clinical needs. In addition, this individual is a sales...of care. 2. Must be knowledgeable of private insurance, Medicare and Medicaid coverage criteria, rules and regulations and… more
- Weill Cornell Medical College (New York, NY)
- …and privacy. Serves as the senior -level liaison representing the organization's clinical compliance and privacy programs to all WCM departments and across ... Title: Executive Director & Clinical Compliance Officer Location: Midtown Org...laws and regulations, including fraud, waste and abuse laws, Medicare Conditions of Participation, the Stark and Anti-kickback statutes,… more
- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** The Senior Quality Compliance Nurse Professional is an integral part of the Oklahoma ... goals and complete time sensitive deliverables for Quality Improvement clinical and non- clinical performance projects. The role...role operates as a subject matter expert in Quality Compliance . The Senior Quality Compliance … more
- Trinity Health (Livonia, MI)
- …knowledge of applicable Federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies & ... relevant experience with increasing levels of responsibility in health care compliance &/or consulting including regulatory compliance , program metrics,… more
- Rush University Medical Center (Chicago, IL)
- …Research Revenue Cycle, this position will create coverage analyses in accordance with Medicare 's Clinical Trial Policy (NCD 310.1) and assist research staff ... provide high-level professional support in the growing efforts to conduct prospective Medicare Coverage Analysis for all clinical research studies. Exemplifies… more
- Rush University Medical Center (Chicago, IL)
- …5:00:00 PM) **Summary:** This position will create coverage analyses in accordance with Medicare 's Clinical Trial Policy (NCD 310.1) and assist research staff ... provide high-level professional support in the growing efforts to conduct prospective Medicare Coverage Analysis for all clinical research studies. Exemplifies… more
- Scripps Health (San Diego, CA)
- …manage time efficently and work to meet the needs of demand. The Chargemaster Senior Analyst provides assistance and analysis to all levels of clinical ... and researches and communicates coverage guidelines for billable services. Works with clinical directors and managers to implement and monitor CDM changes. Provides… more
- University of Michigan (Ann Arbor, MI)
- Reimbursement Analyst Senior Apply Now **How to Apply** A cover letter is required for consideration for this position, and it should be attached as the first page ... and government entities. The reimbursement analyst will maintain current knowledge of Medicare , Medicaid and other State and Federal regulations. The analyst also… more
