- The Cigna Group (Franklin, TN)
- ** Legal Compliance Advisor ** Working cross-functionally with Compliance , Legal , Government Affairs and business stakeholders, this role will be ... accountable for EviCore's Medicaid Compliance program and processes, applicable state...laws and regulations + Ability to engage strategically with legal and business resources to support accurate and effective… more
- The Cigna Group (St. Louis, MO)
- …existing functionality + Review and provide direction on CMS regulations to maintain compliance , partnering with Legal and Compliance + Communicate strategic ... **Product Management Senior Advisor - Medicare Solutions, Express Scripts** **Description of...capabilities are compliant with the Center for Medicare and Medicaid Services (CMS) regulations, lead implementation of enhancements, provide… more
- The Cigna Group (Bloomfield, CT)
- …Recruits and retains network of enterprise resources and collaborates with Client Audit, Compliance , Legal and other stakeholders to respond to State, Center for ... **Overview** The Senior Advisor Regulated Markets Audit Management role is responsible...Medicare and Medicaid Services (CMS) and Client audit requests. **Key accountabilities… more
- Banner Health (Phoenix, AZ)
- …desired and integrated strategic business initiatives, objectives, and outcomes in compliance with legal parameters. 2. Directs, supervises, and evaluates ... **Primary City/State:** Phoenix, Arizona **Department Name:** Legal Svcs-Corp **Work Shift:** Day **Job Category:** Legal Banner Health believes leadership… more
- LA Care Health Plan (Los Angeles, CA)
- …and continuous improvement of the Fraud, Waste, and Abuse (FWA) program, ensuring compliance with Centers for Medicare and Medicaid Services (CMS), Department of ... behavior involving employees, delegated entities, providers, or vendors. Partner with Legal , Compliance , and Human Resources on sensitive internal investigations… more
- Ascendis Pharma (Princeton, NJ)
- …finance, procurement, legal , and contracting partners. Serve as a trusted advisor on contracting and pricing matters, providing guidance and support as needed. ... Operations plays a critical role in driving operational excellence, compliance , and financial performance through effective management of contracting operations.… more
- Providence (Irvine, CA)
- …you'll ensure timely responses to client needs while upholding high standards of legal support and compliance . **What You'll Do** + Advise business clients ... Stark Law, Anti-Kickback Statute, False Claims Act, Medicare and Medicaid billing rules, HIPAA and EMTALA. + Draft and...legal affairs. + Prepare, draft, and review critical legal documents, ensuring compliance with statutes, regulations,… more
- Independent Health (Buffalo, NY)
- … with rebate contracts. + Assist with preparation of Medicare and Medicaid compliance reporting of manufacturer rebate information, including DIR reporting ... of existing and prospective clients. They will work collaboratively with Legal to execute all drug manufacturer contracts, addendums, and amendments.… more
- Independent Health (Buffalo, NY)
- …ensure compliance of rebate contracts. + Assist with Medicare and Medicaid compliance reporting of manufacture rebate information including DIR reporting to ... of existing and prospective clients. They will work collaboratively with Legal to execute all drug manufacturer contracts, addendums and amendments.… more
- WellSpan Health (York, PA)
- …laws, hospital/physician issues, complex contract negotiation and management, Medicare/ Medicaid reimbursement issues, regulatory compliance , patient issues, ... staf, developing and overseeing the OGC budget, and providing legal advice and counsel to WellSpan Health board members,...outside counsel. + Serves as a trusted and strategic advisor to WellSpan Health, hospital and service line leadership.… more
- Waystar (Atlanta, GA)
- …strategic advisor and consultant to designated client groups, including Legal and Client Operations & Transformation, while providing matrixed support to Finance ... YOU'LL DO** **Strategic Partnership** + Act as a trusted advisor to leaders in Legal and Client...a point of contact for employee relations matters, ensuring compliance with federal, state, and local laws. + Promote… more
- Advocates (Framingham, MA)
- …regulators. **Qualifications** 1. 15+ years of leadership experience in risk management, compliance , privacy, or legal affairs within human services, healthcare, ... the strategic development and execution of a comprehensive ethics, compliance , and risk management program. This executive role ensures...and service excellence goals. They serve as a trusted advisor to senior leadership and the Board, fostering a… more
- Guthrie (Sayre, PA)
- …reporting and education purposes. + Collaborate with nursing, physicians, admissions, fiscal, legal , compliance , coding, and billing staff to answer clinical ... tools and peer-reviewed journals. + Provides clinical denial management assistance to Physician Advisor and denials team. + Ensure compliance with all federal,… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Medical Officer (ACMO) serves as a strategic clinical leader and trusted advisor , providing expert guidance across the organization and engaging with key external ... case reviews. * Participate in internal committees focused on quality, compliance , and clinical innovation. Thought Leadership & Communication * Represent Blue… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …for all enterprise quality performance programs across the organization's Medicare, Medicaid , ACA, and Commercial lines of business. This position leads the ... enabling the organization to achieve excellence in quality outcomes, maintain compliance with quality reporting requirements, and optimize member experience and… more
- WestCare Foundation (Henderson, NV)
- …international, federal, and state regulations and payer requirements. + Partner with legal and compliance teams to monitor risk, maintain audit readiness, ... timely and accurate reimbursement for services rendered while maintaining compliance with payer rules, regulations, and organizational policies. The Director… more
- Nestle (Bridgewater, NJ)
- …referral sources. * Collaborate with cross-functional teams including sales, marketing, legal / compliance and medical affairs to align strategies with business ... strategic role the individual will have the opportunity to grow trusted advisor relationships with Large National HME/DME customers within Nestle Health Science.… more
- Grifols Shared Services North America, Inc (Albany, NY)
- …of cost impact to regional or local system/institution/account (financial vs clinical). Legal , Ethics & Compliance : *Ensure appropriate training and alignment to ... territory including major accounts and large players (ie, Commercial, Medicare, and Medicaid ) *Understanding of Hospital formulary with guidance of RSD and NAM/NAD… more
- Grifols Shared Services North America, Inc (Rockford, IL)
- …Legislative impacts to regional or local system/institution/account- leverage Corporate Affairs. Legal , Ethics & Compliance : Ensure appropriate training and ... the territory including major accounts and large players. Medicare and Medicaid information. Coordinate with the Specialty partner to understand the entire… more
- Chiesi (Boston, MA)
- …Trade and Channel Strategy, you will act as a thought-leader and trusted advisor on pipeline and inline product strategy by determining portfolio considerations and ... strategies, product discounting and contractual customer relationships, as well as with Legal , Finance, Customer Service and members of Pricing and Contracts on… more