- 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
- Providence (Portland, OR)
- …experience. + Demonstrate experience with State and Federal and other regulatory Compliance regulations including Medicare Secondary Payor (MSP), EMTALA, ABN, ... must maintain up-to-date knowledge of and competency with numerous regulatory body compliance and safety regulations. Job complexity is evidenced by the performance… 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)
- …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
- 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
- Scripps Health (San Diego, CA)
- …our employees have been with Scripps Health for over 10 years. 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
- CVS Health (Austin, TX)
- …for providing strategic technology support and direction to the Novologix (NLX) Medicare Part B prior authorization operations management and leadership teams. + ... a Novologix functional SME with a focus on delegated Medicare Part B. + Develop, execute, and maintain project...Legal and other organizations. Interface and communicate directly with Senior and Executive leadership from all different areas of… 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
- 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
- Bristol Myers Squibb (Philadelphia, PA)
- …. 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
- Hackensack Meridian Health (Hackensack, NJ)
- …for ensuring compliance with Federal, State, and Local Regulations, Good Clinical Practice (GCP), and Institutional policies and procedures as it relates to all ... internal and external audits, as well as ensuring ongoing compliance of study-related documentation throughout the clinical ...Medicare Coverage Analysis, budget and contract for a clinical trial in order to initiate a review in… 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
- Aveanna (Minnetonka, MN)
- …RN Clinical new hires * Provides ongoing training and educational opportunities for Clinical staff * Serves as a senior member to all staff regarding quality ... Home Health RN Assistant Clinical Manager ApplyRefer a FriendBack Job Details Requisition...agency policy and procedures and state/federal regulation * Ensures compliance with regulations and is available for federal and… more
- Rush University Medical Center (Chicago, IL)
- …requirements specific to Research Billing. * Maintain a detailed understanding of Medicare 's Clinical Trial Policy (NCD 310.1) and related guidance documents. ... Responsible for managing, reconciling and invoicing all revenue secured by Clinical Trials Research Revenue Cycle, work closely with operations, sponsors, and… more
- Beth Israel Lahey Health (Boston, MA)
- …of America) Under the general direction of the Associate Director of the Clinical Trials Office (CTO), the Senior Contracting Specialist works with ... clinical research. + Understands and keeps current with FDA and Medicare regulations applicable to clinical trials. Implements rules, regulations, guidelines… more
- Aveanna (Grand Rapids, MN)
- …RN Clinical new hires * Provides ongoing training and educational opportunities for Clinical staff * Serves as a senior member to all staff regarding quality ... Home Health RN Assistant Clinical Manager ApplyRefer a FriendBack Job Details Requisition...agency policy and procedures and state/federal regulation * Ensures compliance with regulations and is available for federal and… more