- CVS Health (OH)
- …And we do it all with heart, each and every day. **Position Summary** The ** Medicare Compliance Consultant ** is a compliance role that supports ... partnership with - and under the direction of - the health plan, Medicare Compliance Officer, and other team members, this position will help develop 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
- Prime Therapeutics (Columbus, OH)
- …passion and drives every decision we make. **Job Posting Title** Pharmacy Network Consultant Sr - Remote **Job Description** The Pharmacy Network Consultant Sr ... pharmacy networks composition to assess network adequacy, contracting gaps and compliance with regulations + Represent Network Management department in audits and… more
- Elevance Health (Mason, OH)
- **Provider Contract/Cost of Care Consultant Senior** **Location:** This role requires associates to be in-office 1 day per week, fostering collaboration and ... as required by law. The **Provider Contract/Cost of Care Consultant Senior** provides the highest level of analytical support...Uses analytic tools to track both health risks and compliance , as well as supporting the contract negotiation process.… more
- Elevance Health (Mason, OH)
- **Provider Contract/Cost of Care Consultant ** **Location:** This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, ... as required by law. The **Provider Contract/Cost of Care Consultant ** provides analytical support to the Cost of Care...Uses analytic tools to track both health risks and compliance , as well as supporting the contract negotiation process.… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Responsibilities** **Group ... standard formulas and actuarial information, recognizing system requirements and ensuring compliance with state and federal regulations, and adherence to internal… more
- Humana (Columbus, OH)
- …through collaboration with diverse stakeholders across the enterprise, including legal, compliance , education, and IT. In this role, you will contribute to ... the enterprise, including model risk assessments, fairness evaluations, and compliance with ethical and regulatory standards. Champion transparency, accountability,… more
- ChenMed (Maple Heights, OH)
- …mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to be ... acts as a health coach, rather than just a consultant for sickness, by helping patients set short and...with the applicable managers and medical directors to ensure compliance with guidelines along with participating in risk and… more
- Trinity Health (Columbus, OH)
- …, a college of nursing (https://www.mccn.edu/) , a Medicare Advantage plan (https://www.medigold.com/) , and extensive outreach and ... Improvement Activities + o Maintains knowledge of clinical indicators and compliance requirements + o Provides concurrent medical record review for assigned… more
- Cleveland Clinic (Cleveland, OH)
- …with clinical and operational leaders to establish key objectives, ensure compliance with standards and improve performance across safety, quality, utilization and ... data and participate in improvement strategy development. + Act as a consultant in educating and evaluating clinical and support department staff regarding quality… more
- CVS Health (OH)
- …chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative ... clinical tools and information/data. + Utilizes case management processes in compliance with regulatory and company policies and procedures. + Facilitates… more