- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …we need: As an integral part of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as ... escalate to senior leaders for decision making + Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity… more
- The Cigna Group (Bloomfield, CT)
- … support of service operations with specific focus on Medicare clinical programs. The Advisor will ensure operational compliance with all regulatory ... and Clinical Decision Making_ **Role Summary** The Medicare Part D Legal Compliance Advisor is...+ Report to the Senior Manager of Medicare Part D Compliance - Medicare… more
- Medical Mutual of Ohio (OH)
- …any oversight process questions. . Performs other duties as assigned. ** Senior Medicare Pharmacy Coordinator** Working under limited supervision, administers ... mail pharmacy. . Intermediate Microsoft Office skills (Excel, Word, Power Point). ** Senior Medicare Pharmacy Coordinator** . Associate Degree in Business… more
- The Cigna Group (Franklin, TN)
- …and will work in the Franklin, TN office several days per week** ** Medicare Advantage position** The **Manager, Provider Network Contracting** serves as an integral ... of the Provider Contracting Team and reports to the Provider Contracting Senior Manager. This role assists in developing the strategic direction and management… more
- WellSense (Boston, MA)
- …with the physical health teams. Additionally, the Senior Director is responsibleand accountablefortheoverallstrategicdirectionoversight,analysis, clinical ... Senior Director of BH Clinical Programs...company serving members across Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25… more
- CareOregon (Portland, OR)
- …Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Senior Clinical Pharmacist Exemption Status Exempt Department Pharmacy Manager ... inclusion when framing thoughts and ideas. Job Summary The Senior Pharmacy Clinical Coordinator is responsible for...clinical or quality initiatives for both Medicaid and Medicare . + Coordinate with the contracting department on clinic… more
- Humana (Frankfort, KY)
- …to commercial Medicare & Medicaid product implementation, operations, contract compliance , and federal contract application submissions. The Senior Market ... data requires an in-depth evaluation of variable factors. **Location:** remote The Clinical Senior Market Development Professional serves as the primary resource… more
- University of Maryland, Baltimore (Baltimore, MD)
- *The University of Maryland Baltimore has an exciting opportunity**for a Senior Clinical and Corporate Resource & Budget Management Associate (CCT Admin Budget ... **Reg or CII Exempt Staff* **Organization:** **Research and Development - Center for Clinical Trials* **Title:** * Senior Clinical & Corporate Contracts… more
- University of Maryland, Baltimore (Baltimore, MD)
- *The University of Maryland, Baltimore (UMB) is seeking a Senior Associate, Clinical Trials & Corporate Contracts (CCT Contract Admin II). *This position ... clinical and/or corporate contracts and collaboration agreements in compliance with sponsor, federal, state and university policies and regulations. *… more
- AdventHealth (Maitland, FL)
- …32751 **The role you'll contribute:** The Population Health Services Organization (PHSO) Senior Manager of Clinical Documentation Integrity (CDI) will be ... Medical Record tools, Communication protocols, and Quality Assurance (QA) and compliance programs to effectively meet targeted engagement, clinical and… more
- Kestra Medical Technologies, Inc (Kirkland, WA)
- …this role, you will have responsibility for managing all aspects of Kestra sponsored clinical trials for the generation of clinical evidence for the ASSURE ... + Manage all aspects of the ASSURE Patient Registry study including clinical data management, analysis, reporting and abstract/manuscript preparation + Design, plan… more
- PruittHealth (Atlanta, GA)
- …are appropriate for admission to the home health or hospice agency. Provides clinical expertise to our home health and hospice agencies by evaluating their ability ... to meet the patient's clinical needs. In addition, this individual is a sales...of care. 2. Must be knowledgeable of private insurance, Medicare and Medicaid coverage criteria, rules and regulations and… more
- Weill Cornell Medical College (New York, NY)
- …and privacy. Serves as the senior -level liaison representing the organization's clinical compliance and privacy programs to all WCM departments and across ... Title: Executive Director & Clinical Compliance Officer Location: Midtown Org...laws and regulations, including fraud, waste and abuse laws, Medicare Conditions of Participation, the Stark and Anti-kickback statutes,… more
- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** The Senior Quality Compliance Nurse Professional is an integral part of the Oklahoma ... goals and complete time sensitive deliverables for Quality Improvement clinical and non- clinical performance projects. The role...role operates as a subject matter expert in Quality Compliance . The Senior Quality Compliance … more
- Trinity Health (Livonia, MI)
- …knowledge of applicable Federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies & ... relevant experience with increasing levels of responsibility in health care compliance &/or consulting including regulatory compliance , program metrics,… more
- Rush University Medical Center (Chicago, IL)
- …Research Revenue Cycle, this position will create coverage analyses in accordance with Medicare 's Clinical Trial Policy (NCD 310.1) and assist research staff ... provide high-level professional support in the growing efforts to conduct prospective Medicare Coverage Analysis for all clinical research studies. Exemplifies… more
- Rush University Medical Center (Chicago, IL)
- …5:00:00 PM) **Summary:** This position will create coverage analyses in accordance with Medicare 's Clinical Trial Policy (NCD 310.1) and assist research staff ... provide high-level professional support in the growing efforts to conduct prospective Medicare Coverage Analysis for all clinical research studies. Exemplifies… more
- Scripps Health (San Diego, CA)
- …manage time efficently and work to meet the needs of demand. The Chargemaster Senior Analyst provides assistance and analysis to all levels of clinical ... and researches and communicates coverage guidelines for billable services. Works with clinical directors and managers to implement and monitor CDM changes. Provides… more
- University of Washington (Seattle, WA)
- …Affairs, UW Medicine, General Counsel for UW Medicine Nonprofit Entities (" Senior Director/General Counsel"). The UW Medicine Clinical Regulatory Affairs ... Senior Director for the management of UW Medicine clinical business and regulatory affairs to support the activities...contracts and other business documents. Help guide client entity compliance programs, to assure conformity with Medicare … more
- University of Michigan (Ann Arbor, MI)
- Population Health Senior Analyst Apply Now **Summary** This position focuses on providing a combination of strategic and analytic support for the Michigan Medicine ... the state of Michigan who take part in a Medicare -sponsored program to improve quality of care for traditional...in troubleshooting reports, data feeds and inquiries related to clinical quality and cost measures + Connect experts across… more