- Cambia Health Solutions, Inc (Portland, OR)
- …or equivalent related experience, with experience in a health care or Medicare -regulated environment preferred. Compliance Specialist III would have at least a ... General Compliance Analyst II/IIIWork Remotely from Oregon, Washington, Idaho...related experience, with experience in a health care or Medicare -regulated environment or ACA-regulated environment preferred.Work EnvironmentTravel rarely required,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …As an integral part of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as an individual ... to Day: + With minimal oversight, leads CMS utilization management related compliance activities including: + Identify and implement new CMS requirements + Monitor,… more
- Henry Ford Health System (Grand Rapids, MI)
- …and planning and marketing support. Coordinate the development and implementation of Medicare Advantage sales strategies, compliance activities and oversight for ... SUMMARY: Responsible for the retention and growth of the Medicare line of business (both Individual and Group) accounting...Information + Organization: HAP (Health Alliance Plan) + Department: Medicare & Individual Sales + Shift: Day Job +… more
- CVS Health (Moon Township, PA)
- …or concerns. Maintains enrollment data in eligibility systems to ensure compliance with CMS guidance requirements. Required Qualifications + Meet Monthly Metrics ... Supervisor + Keep a positive attitude as changes occur Preferred Qualifications + Medicare industry experience. + Familiarity with Medicare Enrollment systems +… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …manage people + This role reports to this job: Director, Medicare Advantage Compliance & Medicare Compliance Officer + Necessary Contacts: In order to ... administrative elements of the Companies' (LHSIC, HMOLA, and VHP) Medicare Advantage Compliance Program, including development and...Experience** + 7 years Previous experience as a senior compliance consultant or similar role with direct… more
- CVS Health (Hartford, CT)
- …clinical records to apply appropriate clinical criteria and policies in compliance with regulatory and accreditation requirements for members and providers. ... regulatory requirements to support appeals review. + Ensures appeal process compliance with regulatory and accreditation standards. + Counsels with members,… more
- HealthEdge Software Inc (Columbus, OH)
- **Overview** **Overview:** The Business Consultant leads and mentors the Service Delivery team in all Tier 1 (Basic) and Tier 2 (Intermediate) consulting ... Source products (from basic to advanced features/functionality), payment methodologies/policies ( Medicare , Medicaid, and commercial), payment integrity, and healthcare plan… more
- MyFlorida (Marianna, FL)
- OPERATIONS & MGMT CONSULTANT MGR - SES - 67011577 (SUNLAND - ACCOUNTING) Date: May 2, 2024 Location: MARIANNA, FL, US, 32446 MARIANNA, FL, US, 32447 MARIANNA, FL, ... 828529 Agency: Agency for Persons with Disabilities Working Title: OPERATIONS & MGMT CONSULTANT MGR - SES - 67011577 (SUNLAND - ACCOUNTING) Pay Plan: SES Position… more
- WellSense (Boston, MA)
- Provider Relations Consultant (Boston/Northeast MA) - $5,000 sign on bonus! WellSense Health Plan is a nonprofit health insurance company serving members across ... Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25...no matter their circumstances. As a WellSense Provider Relations Consultant , you'll act as the primary liaison between WellSense's… more
- CVS Health (Harrisburg, PA)
- … requirements and communicating the assessment outcomes to the appropriate level of Medicare Claim leadership, Medicare Compliance leadership and Medicare ... care more personal, convenient and affordable. Position Summary The Medicare Part C Claim Audit and Compliance Team works to ensure that Medicare Advantage… more
- State of Colorado (Denver, CO)
- Nurse Consultant RN, Acute Services Care - HFEMS FAA02056 Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4295262) Apply Nurse Consultant ... time of applying. CLASS CODE & CLASSIFICATION DESCRIPTION: Nurse Consultant (C7E1XX) Be BOLD and make a real difference...in the state of Colorado, by evaluating and securing compliance of licensed and certified facilities and providers, utilizing… more
- CVS Health (Trenton, NJ)
- …is a Scrum Team role that will be a member of the Medicare / Medicaid Enrollment Configuration team tasked with developing purposebuilt capabilities for our ... a member of the team to deliver purpose built configuration for the Medicare Enrollment Operations Team on the NextGeneration Platform.* Independently designs and /… more
- AbbVie (Minneapolis, MN)
- …will be hired at a level commensurate with experience. The Account Consultant position manages sales processes for AbbVie's therapeutic products in accordance with ... the franchise goals. Complies with required reports, requests, and promotional compliance and effectively manages AbbVie field Assets Qualifications *Achieve and… more
- Marshfield Clinic (Marshfield, WI)
- …the most exciting missions in the world!** **Job Title:** Compensation Consultant (Remote) **Cost Center:** 101651125 Human Resources **Scheduled Weekly Hours:** 40 ... Mon-Fri; day shifts (United States of America) **Job Description:** The Compensation Consultant works as a key resource within the Human Resources department… more
- MyFlorida (Tallahassee, FL)
- 68064843 - GOVERNMENT OPERATIONS CONSULTANT III - 68064843 Date: May 4, 2024 Location: TALLAHASSEE, FL, US, 32308 The State Personnel System is an E-Verify employer. ... Agency for Health Care Administration Working Title: 68064843 - GOVERNMENT OPERATIONS CONSULTANT III - 68064843 Pay Plan: Career Service Position Number: 68064843… more
- Immigration and Customs Enforcement (IN)
- …DHS, ICE, ERO, IHSC, Office of Deputy Assistant Director for Healthcare Compliance , Office of Health Plan Management. The Senior Utilization Review Consultant ... DUTIES AND RESPONSIBILITIES: Serves in the capacity of Senior Utilization Review Consultant and subject matter expert in program activities and policies related to… more
- Banner Health (AZ)
- …an innovative leader in health care, Banner Plans & Networks (BPN) integrates Medicare and private health plans to reduce healthcare costs while keeping our members ... options by offering remote and hybrid work settings. As a Managed Care Contract Consultant with Banner Plans & Networks, you will utilize your experience in contract… more
- VHC Health (Arlington, VA)
- Quality Consultant Job Description Purpose & Scope: The Quality Consultant is responsible for supporting the organization in four essential domains which include ... Patient Safety, Clinical Quality Management, Regulatory Compliance , and Performance Improvement. Key functions also include collaborating across departments,… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The goal of the Clinical Documentation Specialist- Consultant is to educate leaders, physicians, advanced practice providers (APP), and other ... education plans, interventions, and training. + Acts as an education leader, consultant , and mentor to leaders, physicians, APP's, and other staff about… more
- VHC Health (Arlington, VA)
- Senior Quality Consultant Job Description Purpose & Scope: The Quality Team is responsible for supporting the organization in four essential domains which include ... Patient Safety, Clinical Quality Management, Regulatory Compliance , and Performance Improvement. In conjunction with the AVP of Quality Resource Management and the… more
