- Cedars-Sinai (CA)
- **Job Description** The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring ... healthcare people throughout Los Angeles and beyond. **Req ID** : 11981 **Working Title** : Managed Care Compliance Specialist - Managed Care … more
- MSC Industrial Supply Co. (Sioux City, IA)
- …**Work Location :** Sioux City, IA- **BRIEF POSITION SUMMARY:** The Vendor Managed Inventory (VMI) Specialist ensures customer satisfaction through solutions by ... MSC customer solutions and sales associates through execution of CARE program. + CARE is defined as...incremental solution growth. + Lead focus of 100% safety compliance for VMIS team + Repair and maintain vending… more
- MSC Industrial Supply Co. (Binghamton, NY)
- …**Work Location : Binghamton, NY-** - **BRIEF POSITION SUMMARY:** The Vendor Managed Inventory (VMI) Specialist ensures customer satisfaction through solutions ... collaborate with MSC customer solutions and sales associates through the CARE program (Clean, Arrange, Relationships, Exceed Expectations). + Maintain 6S appearance… more
- MSC Industrial Supply Co. (Indianapolis, IN)
- …**Work Location :** Indianapolis, IN **Brief Position Summary** The **Vendor Managed Inventory (VMI) Specialist ** ensures customer satisfaction through on-site ... customer solutions and sales associates through execution of the ** CARE ** program (Clean, Arrange, Relationships, Exceed Expectations) + Maintain...incremental solution growth + Lead focus of 100% safety compliance for the VMIS team + Lead in the… more
- LA Care Health Plan (Los Angeles, CA)
- Care Management Specialist II, D-SNP Team (12...care professionals in a hospital, medical group or managed care setting, such as a health insurance ... net required to achieve that purpose. Job Summary The Care Management Specialist II utilizes clinical skills...systems. Knowledge of and ability to comply with HIPAA compliance . Ability to interview, assess and coordinate care… more
- Access Dubuque (Dubuque, IA)
- Healthcare Compliance Specialist **Hillcrest Family Services** 1 Positions ID: 554109068 Posted On 09/24/2025 Refreshed On 10/25/2025 **Job Overview** ... **Responsibilities** The ** Compliance Specialist ** is responsible for ensuring that... activities, ensuring confidentiality. + Ensure all documentation is managed in accordance with regulatory requirements. + Other duties… more
- Huron Consulting Group (Chicago, IL)
- …pressure to improve clinical outcomes and reduce the cost of providing patient care . Investing in new partnerships, clinical services and technology is not enough to ... pressure to improve clinical outcomes and reduce the cost of providing patient care . Investing in new partnerships, clinical services and technology is not enough to… more
- Molina Healthcare (Joliet, IL)
- …in healthcare with minimum 2 years' experience in health plan quality improvement, managed care or equivalent experience. + Demonstrated solid business writing ... and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist , Quality… more
- Ventura County (Ventura, CA)
- …the compliance office. Experienced in leading and training staff on Managed Care , Medicaid, Medi-Cal, Medicare, and Commercial Insurance, they ensure ... billing and supervises or conducts training on the specific areas of Managed Care /Medicaid/Medi-Cal/Medicare and/or Commercial Insurance; + Works with the… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred Bachelor's Degree Experience Required: At least 2 years of experience in Managed Care with specific experience in resolving member and provider ... Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department:...apply regulations. At least 5 years of experience in Managed Care working with Medicare, Medi-Cal and… more
- Molina Healthcare (Columbus, GA)
- …experience in healthcare with 1 year experience in health plan quality improvement, managed care , or equivalent experience. + Demonstrated solid business writing ... and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Specialist , Quality Interventions/… more
- Compass Group, North America (Charlotte, NC)
- …the world's largest contract food and support services provider. **Why Foodbuy?** We care about our associates, our clients, and our community. We think big, ... the operational integrity and profitability of contracted programs utilizing a managed order guide for assigned distribution centers. **Responsibilities:** * Review … more
- Valor Health (Bowling Green, KY)
- Clinical Pharmacist Specialist - Primary Care Bowling Green,...patients utilizing rules set forth by the VA for co- managed care . + Completes any and all ... Healthcare is seeking a dynamic and passionate Clinical Pharmacist Specialist (CPS) to provide care at the...Office of Inspector General (OIG), Joint Commission(JC), Environment of Care (EOC) oversight, lab compliance and other… more
- Guidehouse (San Antonio, TX)
- …the ongoing understanding of client and company priorities and expectations + Ensure specialist and project compliance as well as adherence to company/client ... standards and communicate issues of non- compliance to Operations Manager + Monitor specialist ...Supplemental Life + Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts + Short-Term & Long-Term Disability… more
- RTX Corporation (Cedar Rapids, IA)
- …Avionics Quality organization. This role is accountable for ensuring continued compliance with internal and external standards and requirements. This individual will ... have a major impact on the organization's quality and compliance goals. **What You Will Do:** + Serves as...virtual doctor visits + Bright Horizons, child and elder care services + Teladoc Medical Experts, second opinion program… more
- CVS Health (Atlanta, GA)
- …learn the role of care management within Medicare and Medicaid managed care . + **Community Resources:** Familiarity with community resources and services. ... Needs Plan (SNP) care team, the telephonic Care Manager Specialist (CMS) plays a key...with health plan benefits and community resources. + **Regulatory Compliance :** Meet regulatory requirements within specified timelines. + **Consults**… more
- New York State Civil Service (Schenectady, NY)
- …Agency People With Developmental Disabilities, Office for Title Program Operations Specialist 1 Occupational Category Other Professional Careers Salary Grade 18 ... Duties Description OPWDD is required by law to have an effective Medicaid Compliance Program in place. Proactive efforts and resources are needed to mitigate revenue… more
- UNC Health Care (Chapel Hill, NC)
- …Clinical Documentation Specialists (CDS) across all HCS entities that are owned or managed that have opted into shared services. This position reports to the HCS ... conditions, patient safety indicators, hierarchical condition categories and complexity of care rendered to all patients. Educates on proper creation of provider… more
- Merck (North Wales, PA)
- …and stakeholders in the development and pull through of all managed care contract, price, eligibility, and chargeback activities, inquiries, ... **Job Description** The Central Contract Services (CCS) Senior Specialist will function as a vital member of...and Excel **Preferred** + 3+ years business experience in Managed Care Contracting or Pharmaceutical industries. **Required… more
- Houston Methodist (Sugar Land, TX)
- …determinations and, denial reason and trending as appropriate, Monitors CMS, managed care and payor communications for updates/alerts/releases and functions ... + Experience includes writing clinical appeals for medical necessity compliance or level of care for government...Federal, State, and local billing regulations and partners with managed care contracting as needed. + Maintains… more