- 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
- CVS Health (Fresno, CA)
- …report and recommend solutions. Independently coaches others on appeals ensuring compliance with Federal and/or State regulations. Manage control and trend ... the appeal if there is an inquiry from leadership, compliance and State regulators. Understand and adapt to departmental...regulators. Understand and adapt to departmental process and policies. Medicare knowledge is a plus. Fast Turn Around of… more
- BrightSpring Health Services (Arlington, TX)
- …focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacyenvironment. Our organization is inhigh ... calls/claims per hour as determined by the Director and Clinical Hub Manager + Provide clinical support...Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and State Laws, and applicable… 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
- 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
- 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 Michigan (Ann Arbor, MI)
- Reimbursement Analyst Senior Apply Now **How to Apply** A cover letter is required for consideration for this position, and it should be attached as the first page ... and government entities. The reimbursement analyst will maintain current knowledge of Medicare , Medicaid and other State and Federal regulations. The analyst also… more
- LA Care Health Plan (Los Angeles, CA)
- …Plan is a senior leader focused on core operations to improve clinical outcomes for its members. This individual reports directly to the Chief Medical Officer ... Managed Long Term Supportive Services (MLTSS) teams alongside a clinical dyad partner ( Senior Medical Director II)....role extends to all lines of business including Medi-Cal, Medicare , and Commercial. This position holds profit and loss… more
- HCA Healthcare (Fort Myers, FL)
- …and delivery of quality interdisciplinary home health care services. Will ensure compliance to federal/state standards and clinical best practices. **What you ... including addressing deficiencies in clinical documentation, inconsistencies, clinical standards of care, and compliance . **What qualifications… more
- ProMedica Health System (Toledo, OH)
- …of the GMs and RDOs. 4.Responsible for hiring, training, and effectiveness of Senior Care Medicare Ops Specialists. 5.Executes divisional and regional coverage ... *All duties listed below are essential unless noted otherwise* 1.Acts as senior -level liaison and subject matter expert in matters concerning Medical Review… more
- The Cigna Group (Charlotte, NC)
- The Provider Performance Enablement (PPE) Senior Manager is an integral part of a cross-functional, collaborative organization (which includes Market Provider ... Performance, Sales, Health Services, Clinical , Stars & Risk Adjustment, Finance, Marketing, Cross-Segment Contracting, Provider Relations, and Network Development &… more
- Bristol Myers Squibb (Trenton, NJ)
- …. Reporting into the Medical Value Liaison Field Director, the Senior Medical Value Liaison (MVL)/Executive MVL is a field-based role focused ... on applying clinical expertise and experience/knowledge of payors, health policy, payer...policy makers, and other decision makers and influencers. **Responsibilities:** ** Senior Medical Value Liaison** + Provide comprehensive, accurate, fair,… more
- Honor Community Health (Pontiac, MI)
- …monitors progress and completion of certifications and accreditation. + Ensures compliance regarding clinical quality initiatives with necessary regulations and ... Description Reporting to the Chief Medical Officer, the full-time, exempt Director, Clinical Quality is an essential member of a high-performing team that monitors… more
- AdventHealth (Maitland, FL)
- **AdventHealth HIM Coding** ** Senior Medical Coder - Inpatient Coding Specialist** **All the benefits and perks you need for you and your family:** . Paid Parental ... The Inpatient Coder is responsible for reviewing, analyzing, and interpreting clinical documentation in the medical record, applying appropriate ICD-10-CM/PCS coding… more