- Novant Health (NC)
- …to Medicare, Medicaid , and Tricare); + Interpret regulations and identify compliance requirements; + Audit , monitor, and investigate compliance with ... Job Summary The Compliance Consultant is responsible for working...1 year healthcare industry, Required. Minimum 1 year healthcare compliance or related audit experience, Preferred. +… more
- HealthEdge Software Inc (Columbus, OH)
- …payment/policy configuration, provider relations, medical management, medical economics, audit , compliance ) related to implementation/consulting engagements, ... payment/policy related configuration, provider relations, medical management, medical economics, audit , compliance ) + Conduct collaborative scoping sessions… more
- Molina Healthcare (Columbus, OH)
- …project requests and benefit value documentation including high level requirements, compliance implications and cost benefit analysis. * Responsible for business ... urgency, communication and follow through to closure. * Knowledgeable of State Medicaid contract Service Level Agreements. Demonstrates SME knowledge of MCO contract… more
- NHS Management, LLC (Birmingham, AL)
- …Specialist Consultants, Internal Auditor, or any other corporate or regulatory compliance consultant . Communicates progress toward goals and ongoing obstacles ... Specialist Consultants, Internal Auditor, or any other corporate or regulatory compliance consultant . Communicates progress toward goals and ongoing obstacles… more
- Prime Therapeutics (Columbus, OH)
- … with federal laws, state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each State Medicaid ... teamwork across all internal departments, as well as with Medicaid Clients, and an in-depth understanding of all rebate...guidance. + Coordinates with external auditors for yearly SOC-1 audit . + Works directly with Director to fulfill OIG… more
- Houston Methodist (Houston, TX)
- …and works across the hospital to assess, measure, and report ongoing compliance with standards, promote evidence-based best practices, and standardize common survey ... processes. Additional responsibilities include functioning as a consultant /surveyor, conducting internal surveys, and providing guidance and direction with on-site… more
- Nuvance Health (Danbury, CT)
- …on charging functions, workflows and analysis of the medical record. The audit process begins with registration, orders and clinical workflows. Ensures that the ... carve out exclusion to identify specific implantable devices. c. Acts and a consultant to Service Lines and Business United to ensure an accurate Soarian Financials… more
- Houston Methodist (Houston, TX)
- …regulatory program requirements and activities. The position serves as a consultant , resource, mentor, and educator for regulatory and accreditation programs; works ... across the system to assess, measure, and report compliance with standards; and develops, implements and evaluates strategies...surveys across the HM system using ISO 9001 process audit tools and techniques to evaluate the effectiveness of… more
- CVS Health (Tallahassee, FL)
- …will improve members health status, members adherence to care plan, and compliance with coordinated services. + Reviews documentation and evaluates potential quality ... determinations. + Conducts outbound telephone calls to members regarding service compliance with behavioral health providers. + Considers all documented system… more
- MyFlorida (Macclenny, FL)
- …for the coordination, development, and implementation of nursing procedures in compliance with professional nursing standards, the Joint Commission on Accreditation ... of Hospitals, Agency for Health Care Administration, and the Centers for Medicaid and Medicare Services. + Performs periodic quality care reviews and develops,… more