- CVS Health (KS)
- …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
- Highmark Health (Charleston, WV)
- …are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with ... STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the needs… 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
- Baylor Scott & White Health (Austin, TX)
- JOB SUMMARY The Third Party Compliance Consultant Sr performs ongoing activities related to the development, implementation, maintenance of, and adherence to ... a timely way. . Responds to inquiries utilizing applicable Medicare and Medicaid guidance. Serves as a compliance... Medicare and Medicaid guidance. Serves as a compliance resource to BSWH departments and entities on … more
- Humana (Oviedo, FL)
- …put health first** The Nurse Senior Stars Improvement, Clinical Professional/ Consultant contributes to the development, implementation, and management of the ... company's Medicare /Medicaid Five-Star Quality Rating System. The Senior Stars Improvement,...Experience. The Nurse Senior Stars Improvement, Clinical Professional / Consultant focuses on areas of clinical emphasis related to… more
- Banner Health (AZ)
- …knowledge of laws and regulations pertaining to health care, regulatory compliance , Medicare /Medicaid and/or financial reimbursement systems. Must possess strong ... **Department Name:** Compliance -Corp **Work Shift:** Day **Job Category:** Compliance **Estimated Pay Range:** $40.91 - $68.19 / hour, based on location,… more
- MyFlorida (Tallahassee, FL)
- …and reviews applications and supporting documents for completeness, accuracy and compliance with state licensure and/or Medicare certification requirements ... 68061377 - HEALTH SERVICES & FACILITIES CONSULTANT Date: Sep 30, 2025 The State Personnel...for all matters pertaining to the state licensure and/or Medicare certification of assigned programs, and for the coordination… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross and Blue Shield of Minnesota Position Title: Senior Policy Consultant Location: Hybrid | Eagan, Minnesota Career Area: Corporate Affairs About Blue ... You Will Have Blue Cross Blue Shield MN is looking for a Senior Policy Consultant to join our team. This position is responsible for serving as the principal policy… more
- PruittHealth (Norcross, GA)
- **HomeHealth Consultant position - Hybrid and Travel opportunity!** **JOB PURPOSE:** The Home Health Consultant collaborates with the Home Health Agencies by ... evaluating and educating agencies/facility staff for compliance with all regulatory groups by making recommendations and suggestions for improvement. Track, trends… more
- PruittHealth (Fayetteville, NC)
- …Senior Vice President Clinical Services and the hospice regional team to provide compliance support services to hospice agencies. The consultant is responsible ... program evaluation, education and monitoring functions to determine agency compliance with all regulatory groups and make recommendation/suggestions for improvement.… more
- Humana (Columbia, SC)
- …customers at the center of everything it does. The Growth Strategy Consultant (Distribution) provides data-based strategic direction to identify and address business ... support for the Enterprise Growth vertical. The Long-term Growth Strategy Consultant 's work involves moderately complex assignments performed with limited direction… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Cross and Blue Shield of Minnesota Position Title: Risk Adjustment QA Consultant Location: Hybrid | Eagan, Minnesota Career Area: Customer Service/Operations About ... Will Have As a Risk Adjustment Quality Assurance (QA) Consultant at BCBSMN, you'll play a critical role in...a critical role in ensuring the accuracy, completeness, and compliance of risk adjustment coding across both internal teams… more
- AccentCare, Inc. (San Bernardino, CA)
- Overview Hospice Care Consultant Location: San Bernardino Position: Hospice Care Consultant Job ID: Position Type: Full-Time Remote/Virtual Position: No Coverage ... Area: Riverside Find Your Passion and Purpose as a Hospice Care Consultant Salary: 85K-110K + commission #AC-BSL Offer Based on Years of Experience esedical Sales… more
- MyFlorida (Tallahassee, FL)
- 68064926 - SENIOR INFO TECH BUSINESS CONSULTANT / TECHNICAL WRITER & COMMUNICATIONS Date: Sep 26, 2025 The State Personnel System is an E-Verify employer. For more ... Health Care Administration Working Title: 68064926 - SENIOR INFO TECH BUSINESS CONSULTANT / TECHNICAL WRITER & COMMUNICATIONS Pay Plan: Career Service Position… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** This Senior Consultant , Enterprise Rule & Edits position reports to our Enterprise Rules & Edits Manager and has the responsibility for ... active involvement in scoping, project planning, implementation, and stabilization. The Consultant will leverage billing and coding subject matter expertise and… more
- The County of Los Angeles (Los Angeles, CA)
- HEALTH FACILITIES CONSULTANT , NURSING Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2307969) Apply HEALTH FACILITIES CONSULTANT , NURSING ... nursing facilities, and related health facilities to assist them in achieving compliance with State and Federal nursing regulations, and with the professional staff… more
- Prime Therapeutics (Atlanta, GA)
- …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
- Signature Healthcare (Indianapolis, IN)
- …of choice in the healthcare industry. Overview The ideal Signature Clinical Care Consultant Candidate would have working knowledge of Medicare , Medicaid and ... standards of care are in place to achieve clinical, regulatory, and reimbursement compliance . + Provide oversight and guidance to staff in assigned facilities, which… more
- Elevance Health (Atlanta, GA)
- **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
- US Tech Solutions (RI)
- …to obtain additional information. + Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines. + ... Medcompass + Must have prior authorization utilization experience. + Managed Care/ Medicare experience preferred. **Skills:** + MUST HAVE MEDCOMPASS or ASSURECARE… more