- Public Consulting Group (Cedar Rapids, IA)
- …www.publicconsultinggroup.com . **Responsibilities** + Responsible for coordinating program integrity -related reviews with the medical necessity review ... review manager conducting, directing, or leading medical necessity reviews of Medicaid managed care and/or program... necessity reviews of Medicaid managed care and/or program integrity investigations preferred + Previous supervisory… more
- Trinity Health (Livonia, MI)
- …of applicable Federal, State, and local laws and regulations, Trinity Health's Organizational Integrity Program , Standards of Conduct, as well as other policies ... and how it may be applied across the region, appeals, denial prevention, medical necessity , and coding audits. Previous Charge Description oversight required;… more
- LifePoint Health (Martinsville, VA)
- …evaluate and measure revenue integrity operations; develops systems to manage medical necessity denials; and develops tracking mechanisms to measure loss ... refers to financial counselors for follow up. . Performs medical necessity check, when appropriate (if not...Illness Bank package for full-time employees . Employee Assistance Program - mental, physical, and financial wellness assistance .… more
- Waystar (AR)
- …hospital inpatient record types, clinical documentation, payer reimbursement methodology, medical necessity criteria, billing requirements and applicable ... **ABOUT THIS POSITION** We are looking for a Revenue Integrity DRG Auditor who has a comprehensive understanding of hospital Revenue Cycle Management. Significant… more
- AmeriHealth Caritas (Columbus, OH)
- …meetings providing clinical consultation, and holds final authority for recommendations for medical necessity and appropriateness or quality of care decisions. ... care practitioner with oversight of the Quality Improvement (QI) program . The Behavioral Medical Director is an...Medical Director supports the clinical department in applying Medical Necessity Criteria, to render determinations to… more
- Magellan Health Services (Dallas, TX)
- …including regular involvement in the case management of at-risk cases and medical necessity decisions. Follows high risk cases throughout treatment continuum ... management plans. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure...implementation, training and supervision of the use of the medical necessity criteria. + Along with the… more
- CVS Health (Springfield, IL)
- …of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) ... most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental...Suite Education * Must be graduate of an accredited Medical School and Residency Program * ABMS or… more
- MyFlorida (St. Petersburg, FL)
- …cost effective, quality health care. Authorized to limit services based on medical necessity and procedural guidelines. Uses professional guidelines for ... This position is an Analyst within the Specialty Care Program , whose primary functions are to generate medical...Specialty Care. Develops procedures to evaluate medical necessity . + Evaluates authorization requests for… more
- State of Minnesota (St. Paul, MN)
- …eligible._** **_*Approximately, 5% travel._** _This position exists to direct and coordinate program integrity efforts with the substance use disorder (SUD) ... contractor managing medical necessity post-payment reviews as a requirement...Office of the Inspector General (OIG), and will follow program integrity investigation standards, but will be… more
- Molina Healthcare (Bothell, WA)
- …training, and supervision of the use of the criteria for medical necessity . + Participates in and maintains the integrity of the appeals process, ... + Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements… more
- Highmark Health (Charleston, WV)
- …A key component of this role is to review denials of care based on medical necessity . The incumbent acts as a liaison for Highmark Wholecare with ... to provide clinical consultation and support with regard to program development, compliance with accepted medical standards,...Wholecare's core values, Code of Business Conduct and the Integrity Process + Foster a reprisal free environment to… more
- RTX Corporation (Haltom City, TX)
- …Demand, virtual doctor visits + Bright Horizons, child and elder care services + Teladoc Medical Experts, second opinion program + And more! Learn More & Apply ... be part of a dynamic team that values innovation, integrity , and excellence? Do you want to have a...Collins Aerospace is the place for you! As a Program Finance Manager located onsite at our Haltom City,… more
- RTX Corporation (Mckinney, TX)
- …virtual doctor visits + Bright Horizons, child and elder care services + Teladoc Medical Experts, second opinion program + And more! Learn More & Apply ... seeking leaders with a engineering technical background and experience is system integrity to support a rapidly growing organization with exciting opportunities in… more
- RTX Corporation (Windsor Locks, CT)
- …Demand, virtual doctor visits * Bright Horizons, child and elder care services* Teladoc Medical Experts, second opinion program * And more! At Collins, the paths ... unit is looking to hire a Boeing 777X Deputy Program Chief Engineer to join our team in Windsor...the industry. Their ideas drive our performance, and their integrity keeps our customers happy. Join us as we… more
- RTX Corporation (East Hartford, CT)
- …our employees to be their whole - best - selves at work because trust, respect, and integrity , are a part of our DNA. At Pratt & Whitney, the difference you make is ... individual to join its Fighter Mobility team as a Program Analyst on the F119 SPaRE Program .... Contract Data Requirement Lists (CDRLs). + Promote data integrity by properly controlling and monitoring EV systems (wInsight,… more
- RTX Corporation (Lenexa, KS)
- …virtual doctor visits + Bright Horizons, child and elder care services + Teladoc Medical Experts, second opinion program + And more! Nothing matters more to ... Position Role Type: Onsite Position Overview: The Beverage Maker Program Chief team is accountable for all Engineering ...team and customers' needs, all while operating with full integrity . Collins Aerospace, a Raytheon Technologies company, is a… more
- RTX Corporation (Windsor Locks, CT)
- …Demand, virtual doctor visits + Bright Horizons, child and elder care services + Teladoc Medical Experts, second opinion program + And more! May be eligible for ... P&C US region? As the Senior Manager, Global Trade Program Management, you'll be at the forefront of ensuring...Offer Some of our competitive benefits package includes: + Medical , dental, and vision insurance + Three weeks of… more
- RTX Corporation (Cedar Rapids, IA)
- …Benefit + Doctor on Demand, virtual doctor visits + Adoption Assistance + Teladoc Medical Experts, second opinion program + And more! At Collins, the paths ... Collins Aerospace is searching for an Associate Director - Program Chief to join our team. We like to...needs, anticipates project/organizational change, all while operating with Full Integrity . This is an onsite position based in Cedar… more
- RTX Corporation (Everett, WA)
- …fostering strong partnerships with stakeholders. + Conduct data analysis to maintain program integrity across all critical parameters. + Facilitate workflow ... Bright Horizons, child and elder care services + Teladoc Medical Experts, second opinion program + And...posted. However, factors such as candidate flow and business necessity may require RTX to shorten or extend the… more
- RTX Corporation (Chula Vista, CA)
- …Demand, virtual doctor visits + Bright Horizons, child, and elder care services + Teladoc Medical Experts, second opinion program + And more! Learn More & Apply ... Role Type: Onsite Collins Aerospace is looking for a Program System Integration Manager who will be an individual...with an ERP system, SAP What We Offer + Medical , dental, and vision insurance + Three weeks of… more