- Highmark Health (Nashville, TN)
- …including the growing number of laws and regulations governing managed care organizations. The Manager , Medicaid Compliance & Operations acts as a trusted ... contracts. The position actively manages the day-to-day operations of the Medicaid Compliance Program, and contributes to the operational workflow for … more
- Humana (Nashville, TN)
- …development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root ... a part of our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence… more
- Prime Therapeutics (Nashville, TN)
- …Posting Title** Manager , Compliance - Remote **Job Description** The Compliance Manager works closely with designated business areas, Legal, and other ... Expertise in their areas of focus (Affordable Care Act, Medicare, Medicaid , Corporate Compliance , Compliance Assessment or Services etc.) + Develop and… more
- Prime Therapeutics (Nashville, TN)
- … with federal laws, state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each State Medicaid ... passion and drives every decision we make. **Job Posting Title** Manager Rebate Pharmacy Operations **Job Description Summary** This position provides administrative… more
- HCA Healthcare (Brentwood, TN)
- …to be a part of our team. **Job Summary and Qualifications** As Reimbursement Manager , you will complete Medicare and Medicaid cost reports to obtain appropriate ... an organization that invests in you as a Reimbursement Manager ? At HCA Healthcare, you come first. HCA Healthcare...reimbursement from these programs and monitor hospitals' compliance with the company's reimbursement policies and procedures. Your… more
- HCA Healthcare (Nashville, TN)
- …to make a difference. We are looking for a dedicated Regulatory and Accreditation Clinical Compliance Audit Manager ? like you to be a part of our team. Job ... well as corporate responsible personnel to help effect overall compliance . The Clinical Compliance Audit Manager...The Joint Commission (TJC), The Centers for Medicare and Medicaid Services (CMS), federal and state regulations. * Performs… more
- Prime Therapeutics (Nashville, TN)
- …and ability to adjust focus **Reporting Structure** + Reports to Sr Professional, Manager , Director or Senior Director in the Compliance department Potential pay ... our passion and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Interpretation and Advising) - Remote **Job Description** The Senior … more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Billing Specialist I - Payment Compliance is responsible for processing, auditing, and submitting primary and secondary insurance claims, ... ensuring accuracy, compliance , and timely reimbursement. This role utilizes electronic claims...unresolved issues or billing delays to the Billing Services Manager . + Communicates professionally with payers, facility representatives, and… more
- Humana (Nashville, TN)
- …our caring community and help us put health first** The **Telephonic Nurse Case Manager ** will be a member of the Case Management Team, providing a comprehensive, ... holistic approach for case management throughout the continuum of care. The case manager will offer guidance. support, and coordination of the beneficiary's care as… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a Senior Project Manager II? At Parallon, you come first. HCA Healthcare has committed up to $300 million ... the opportunity to make a difference. We are looking for a dedicated Senior Project Manager II like you to be a part of our team. **Job Summary and Qualifications**… more
- CVS Health (Nashville, TN)
- …team with Aetna, a CVS Health company. As a Senior Program Manager for Interoperability, you will be responsible for product post-production support of ... Interoperability team, you will work collaboratively with Business, Clinical, Architecture, Compliance , IT, and Legal to deliver technologies and processes that… more
- HCA Healthcare (Nashville, TN)
- …and integrity. We care like family! Jump-start your career as a Project Manager II today with Parallon. **Benefits** Parallon, offers a total rewards package that ... Eligibility for benefits may vary by location._** Come join our team as a Project Manager II. We care for our community! Just last year, HCA Healthcare and our… more
- Humana (Nashville, TN)
- …of our caring community and help us put health first** The Lead Product Manager conceives of, develops, delivers, and manages products for customer use. The Lead ... Product Manager works on problems of diverse scope and complexity...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Datavant (Nashville, TN)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Analytics Products, you will contribute to the strategy and ... and support value-based client delivery across Medicare Advantage, ACA, and Medicaid programs. The ideal candidate combines deep healthcare analytics expertise with… more
- Aveanna Healthcare (Franklin, TN)
- Home Health RN or PT Clinical Manager Full Time ApplyRefer a FriendBack Job Details Requisition #: 205490 Location: Franklin, TN 37064 Category: Nursing Salary: ... year Position Details **Must have Home Health & Oasis experience** TheRN Clinical Manager - Home Healthworks under the direction and guidance of the Branch… more
- Evolent (Nashville, TN)
- …Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Manager , Provider Data Operations** **What You Will Be Doing:** The Manager , ... understanding of US health care, Managed Care Organizations, and/or Medicaid + Lives the values: Communicate with Candor, Start...part of the application process. This is collected for compliance and security purposes and only reviewed if an… more
- Lundbeck (Nashville, TN)
- …anticipate and effectively address payer access issues (IDNs, Medicare, Medicaid , Commercial) using Lundbeck resources. **Pharmaceutical Environment/ Compliance ** ... Psychiatry Account Manager - Nashville East, TN Requisition ID: 5734...on our journey of growth! As a Psychiatry Account Manager , you lead the promotion of our psychiatry portfolio,… more
- Community Health Systems (Franklin, TN)
- …of evaluation and management services, procedures, and other physician work in compliance with Medicare, Medicaid , and other payer requirements. + Identifies ... CHS-affiliated providers and staff on accurate coding and documentation to ensure compliance with federal, state, and local laws. This role involves conducting… more
- Elevance Health (Nashville, TN)
- …Amerigroup, is a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services ... to Medicaid plans in partnership with blue cross blue shield...to a model based on quality achievement. + Ensures compliance with all regulatory and accreditation standards (local and… more
- HCA Healthcare (Nashville, TN)
- …clinical knowledge of various abstracted measures. + Communicate in a timely manner with manager to achieve measure compliance . + Submit data timely through the ... agencies (eg, CMS, TJC, NHSN, etc.). + Performs timely abstraction to ensure compliance with standards. + Completes edit checks and makes appropriate changes on a… more