- PharmaCord (Cincinnati, OH)
- …ability to think critically and issue resolution. Knowledge of healthcare compliance regulations, including HIPAA and Medicare /Medicaid guidelines. Bi-lingual ... When you join the team as an Executive Case Manager , you'll have the opportunity to make a difference...are handled in a timely manner. An Executive Case Manager has the ability to translate knowledge into patient… more
- Sprenger Wellspring Silver Maple (Lorain, OH)
- …discharge. Utilizing physician's orders and professional skills, the RN functions as a case manager and develops and implements a Home Health plan of care that meets ... each patient's specific needs and is in compliance with State and Federal Home Health regulations, reimbursement guidelines, as well as Wellspring Home Health… more
- Knox Community Hospital (Mount Vernon, OH)
- …System ( MIPS ) and alternative payment models offered by Centers for Medicare and Medicaid Services (CMS) and patient centered medical home models. Ability to ... Microsoft Applications Hospital Information Systems Computerized Documentation Systems (CDS) Compliance Manuals/Resources PRIMARY JOB RESPONSIBILITIES Perform concurrent and retrospective… more
- Medical Mutual of Ohio (OH)
- …responsible for leading the implementation and day-to-day management of Medical Mutual's Medicare Compliance Program, which supports both Medicare Advantage ... **Responsibilities:** + Manages the implementation and operation of the Medical Mutual Medicare Compliance Program. + Serves as Medical Mutual's Medicare … more
- CVS Health (OH)
- …processes, procedures, and systems to ensure consistent results and organizational compliance with regulations related to the organization's Medicare Part ... with heart, each and every day. As the Senior Manager , Aetna Medical Pharmacy, you will be accountable for...business projects and programs and managing operations within the Medicare Part B Pharmacy Team. You will act as… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …value based contracts and gap closure work. This Population Health Clinical Quality Manager will support the Medicare Shared Savings Program (MSSP) value-based ... care model. **Primary Function/General Purpose of Position** The Manager of Population Health Clinical Quality is responsible for planning, directing, executing and… more
- OhioHealth (Columbus, OH)
- …Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position ... will be responsible for ensuring the appropriate governmental ( Medicare and Medicaid) reimbursement is received for OhioHealth. * This position is primarily… more
- Humana (Dayton, OH)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...Agents, you'll work under the guidance of a Senior Manager and Regional Director who are committed to your… more
- Molina Healthcare (OH)
- …business areas and owners to ensure processes and reporting exists to demonstrate compliance to regulatory requirements. * Supports Manager and Director with ... to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Sr. Analyst develops and… more
- Cardinal Health (Columbus, OH)
- …of the annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory responsibility for all Compliance Audit staff. **_What is ... **_What Ethics & Compliance contributes to Cardinal Health_** Ethics & ...facility fee coding and auditing. + Expert-level knowledge of Medicare and Medicaid documentation and coding rules and guidelines;… more
- Elevance Health (Columbus, OH)
- ** Compliance Manager ** **Location:** This role requires associates to be in-office 1 - 2 days per week at one of our four Ohio offices (Cincinnati, Columbus, ... for employment, unless an accommodation is granted as required by law. The ** Compliance Manager ** is responsible for managing foundational and strategic … more
- Humana (Columbus, OH)
- …for licensed, highly motivated and self-driven individuals to join our team. Our Senior Manager , Medicare Sales, motivates and drives a team of Medicare ... and train a team of sales individuals. The Senior Manager , Medicare Sales, must have a solid...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Elevance Health (Columbus, OH)
- …of managerial experience is strongly preferred + Experience with IRE/Maximus and Medicare compliance , programs, guidelines, and processes are strongly preferred. ... ** Manager II Grievance/Appeals** **- Claims Support** **Office Locations:**...and operational and plan risk, ensures quality, and regulatory compliance . This role specifically oversees the IRE Team. **How… more
- Humana (Columbus, OH)
- …community and help us put health first** The Special Investigations Unit Manager leads and monitors investigations of allegations of fraudulent and abusive ... practices. The Manager , Fraud and Waste works within specific guidelines and...+ Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of experience with… more
- ICF (Columbus, OH)
- …extending offers in anticipation of the award. ICF is currently seeking a Data Manager to lead and oversee program integrity data analysis activities in support of a ... federal health agency. The Data Manager will be responsible for managing data analysis operations,...role requires a deep understanding of healthcare data systems, Medicare and Medicaid claims, and the government's healthcare fraud,… more
- Humana (Columbus, OH)
- …part of our caring community and help us put health first** The Care Manager , Telephonic Nurse 2, in a telephonic environment, assesses and evaluates members' needs ... resources appropriate for the care and wellbeing of members. The Care Manager , Telephonic Nurse 2 work assignments are varied and frequently require interpretation… more
- Humana (Columbus, OH)
- …of the business there is limited day to day flexibility in care manager 's schedule. **Duties:** + Telephonically assess Medicare , Medicaid, and/or and Group ... community and help us put health first** The Care Manager , Telephonic Nurse 2 employs a variety of strategies,...advanced communication and interpersonal skills. This is a very compliance driven and highly visible program at Humana. The… more
- J&J Family of Companies (Columbus, OH)
- …Engagement and Customer Solutions (PECS) team is recruiting for a Field Reimbursement Manager which will be a field-based position that will include the Columbus, ... help overcome challenges to fulfillment, on-boarding, and adherence. The Field Reimbursement Manager (FRM) is responsible for serving as the primary field-based lead… more
- Humana (Columbus, OH)
- …our caring community and help us put health first** The Print Project Manager is responsible for overseeing the efficient operation and continuous improvement of the ... issues to ensure optimal performance of print services. The Print Project Manager collaborates with stakeholders across the organization to drive process efficacy… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Manages enterprise ... projects, programs, and teams with support, in compliance with the Company's defined project management standards with the goal of delivering project objectives on… more
