- Daiichi Sankyo, Inc. (Bernards, NJ)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... but not limited to, areas of GPO/PBM and trade/distribution agreements, Medicare , Medicaid, product pricing, and government price reporting. Coordination with, and… more
- Novo Nordisk Inc. (WA)
- …Corporate Tax, as well as other Market Access & Public Affairs teams, Medical , Legal, Compliance , Communications and other key stakeholders locally and globally. ... External relationships include select federal agencies that may develop health care policies that...insights from other departments (Corporate Tax, MA, Comm'l BUs, Medical , Regulatory, Legal, etc) Assigned policy areas may include,… more
- Merck & Co. (North Wales, PA)
- …agency partners and focus on various customer segments (eg health plans, Medicare , Medicaid, federal , pharmacy, hospital, Group Purchasing Organization s, etc.). ... Customer Access and Reimbursement, Marketing, Integrated Account Management Teams, CORE, Medical Affairs, etc.).-- This role will focus on collaborating with brand… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …perform pre-employment substance abuse and nicotine testing._ **Title:** _Senior Medicare Compliance Analyst_ **Location:** _OH-Brooklyn_ **Requisition ID:** ... hybrid role reporting to Brooklyn, Ohio._** Founded in 1934, Medical Mutual is the oldest and one of the...and manages the implementation and daily operation of the Medicare Advantage Compliance Program and all … more
- CVS Health (Southfield, MI)
- …individual will work independently, as well as collaboratively, with internal senior level Medicare compliance and business teams that operate MMP and DSNP ... the CVS Code of Conduct * Maintains current working knowledge and expertise in Medicare Compliance , Medicaid Compliance and State regulations in support of… more
- Humana (Columbus, OH)
- …of situations or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical ... Oncology or Surgery specialties + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid,… more
- CVS Health (New Albany, OH)
- …personal, convenient and affordable. **Position Summary** In support of the Chief Medicare Officer, the candidate has responsibility for ensuring that the local ... Medicare business is compliantly and effectively operating in the...CMS required activities and processes including the accuracy and compliance of the annual bid application, expansion application, member… more
- Centene Corporation (Jefferson City, MO)
- …+ Provide legal advice and services including advising management concerning state and federal legislation with a focus on Medicare Advantage and Prescription ... Stars, broker/sales, grievances and appeals, utilization management, dual eligible special needs plans, medical loss ratios, and other areas of Medicare a plus.… more
- Cleveland Clinic (Cleveland, OH)
- …team, patient financial services, clinical research billing office, IRB, and research compliance related to Medicare coverage analysis issues and determinations. ... coverage analysis as required by NCD 310.1 and the Federal Clinical Trials Policy (CTP). + Ensure research billing...experience (10 years' experience total). + Knowledge of billing compliance and Medicare regulations. + Excellent oral… more
- Providence (OR)
- …to optimize performance + Analyzing and interpreting regulatory guidance to ensure compliance with Medicare Advantage bid requirements + Collaborating with ... empower them._** **Providence Health Plan is calling a Senior Actuarial Analyst, Medicare Bid who will:** + Be responsible for developing and maintaining actuarial… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …research activity in an academic medical center + Knowledge of billing compliance and Medicare regulations/policy, applicable federal , state, and local ... The Medicare Coverage Analyst (MCA) is responsible for reviewing...Medicare Clinical Trial Policy (NCD 310.1) and designates medical procedures/services based on relevant regulations and determinations. The… more
- RWJBarnabas Health (Oceanport, NJ)
- …and DRG assignment for adherence to Federal and State Regulations and Compliance Guidelines. + Critically analyzes each Medicare inpatient medical record ... sustain an excellent organizational average accuracy rate. Adherance to applicable Federal and State Regulations, Compliance Guidelines, and Coding Guidelines… more
- VNS Health (Manhattan, NY)
- …of polices concerning medical services for Health Plan members.* Ensures compliance with relevant and applicable federal , state and local laws and ... and guidance to the daily operations and administration of medical management for VNS Health Plans. Assists senior leadership...regulations. Works with Compliance and Special Investigation Unit on issues related to… more
- CVS Health (Columbus, OH)
- …to make health care more personal, convenient and affordable. **Position Summary** The Federal Employee Program (FEP) is one of the largest CVS Health PBM clients. ... The Medicare Business Analytics - FEP - Sr. Manager provides...are visible to leadership and operational teams to ensure compliance and client profitability. **Required Qualifications** + 5+ years… more
- Humana (Columbus, OH)
- …part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The Corporate ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- Lowe's (Charlotte, NC)
- …in managing medical treatment to an appropriate resolution. Apply medical treatment guidelines for future Medicare -covered expenses. The candidate will ... costs + Utilize clinical and nursing skills to develop Medical Cost Projections and Medicare Set-Asides for...status, genetic information, or any other category protected under federal , state, or local law._ _Qualified applicants with arrest… more
- Prime Healthcare (Redding, CA)
- …in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare -Medicaid. This includes maintaining the ... education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/187983/sr- medicare -medicaid-biller-collector/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityShasta Regional Medical Center… more
- Humana (Columbus, OH)
- …our caring community and help us put health first** The Group Medicare Proposal Development Professional reviews solicitations and prepares routine contract review ... requests for proposals (RFPs)/request for renewals (RFRs). The Group Medicare Proposal Development Professional is primarily responsible for reviewing moderate… more
- CVS Health (Tallahassee, FL)
- …members' health care and social determinant needs. The Case Management (CM) Medical Director will participate in designing, developing and deploying our Models of ... reside in Florida and and must have a Florida medical license or be willing to obtain one. **Primary...that objectives are aligned, business strategies are delivered, and compliance and quality objectives are met. * Consults with… more
- CVS Health (Carson City, NV)
- …for ensuring broker adherence to all CMS and Aetna guidelines by monitoring compliance with state, federal , and health plan regulatory requirements. - Maintains ... Candidates will sit in the Las Vegas Nevada area** Aetna is looking for a Medicare Sales Broker Manager to join the Nevada sales team that drives and achieves sales… more
