- Molina Healthcare (Lexington, KY)
- **Molina Healthcare ** is hiring for a **Sr Business Analyst** with experience in ** Managed Care Compliance ** . This role is **100% Remote** and open to all ... any vendors involved. **Highly Qualified Candidates Will Have the Following:** + Compliance experience (audits, CAPs, regulatory requirements, etc.). + Be able… more
- Roper St. Francis (Ladson, SC)
- …of managed care arrangements, including value-based arrangements, ensuring compliance with contractual agreements and regulatory requirements. + Monitor ... managed care processes with overall organizational goals. + ** Compliance & Quality Assurance:** + Ensure adherence to federal,...Managed Care - Contracting - Roper St Francis Healthcare _It is our policy to abide by all… more
- Dignity Health (Bakersfield, CA)
- …Dignity Health MSO. - Establish and enforce policies and procedures to ensure compliance with regulatory requirements and industry standards. - Oversee the ... care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health… more
- Robert Half Legal (Burlington, NC)
- …and working with outside counsel. Responsibilities: * Conduct compliance and regulatory research within the healthcare industry * Review and negotiate ... of legal-hold notices * Manage service of process in compliance with legal standards * Use your skills in...professional setting * Demonstrated knowledge and experience in Medicaid Managed Care * Familiarity with healthcare regulations… more
- MaineGeneral Health (Waterville, ME)
- …and payer enrollment. The successful candidate will have a deep understanding of healthcare finance, regulatory requirements, and a proven track record in a ... or related field (Master's preferred) + Minimum of 7 years of experience in healthcare reimbursement and managed care - some leadership experience is preferred +… more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: Reporting to the Director - Managed Care Contracting, this position is responsible for managing the payor contracting functions for the hospitals, ... of Henry Ford Health. This position is responsible for leading the Managed Care Contracting team in evaluating, analyzing, and negotiating contract terms and… more
- ManpowerGroup (Columbia, SC)
- …in data collection and input clinical information for claims adjudication. + Ensure compliance with regulatory guidelines (eg, ERISA, NCQA, URAC, DOI, DOL). ... **Title: Coordinator, Managed Care I** **Location: 4101 Percival Road Columbia...Education (10%):** + Provide direct intervention and education regarding healthcare delivery, utilization, and benefit plans. + Act as… more
- Fallon Health (Worcester, MA)
- …improvement activities to ensure that Fallon members receive quality care in compliance with regulatory and contractual requirements. + Reviews and abstracts ... outcomes. Other key responsibilities include medical record data abstraction for Healthcare Effectiveness Data and Information Set (HEDIS(R)) and MassHealth Appendix… more
- Sutter Health (Goleta, CA)
- …(TJC). A broad knowledge base of post-acute levels of care and associated regulatory compliance requirements. Must be able to effectively communicate with, and ... & LICENSURE:** + RN-Registered Nurse of California + BLS-Basic Life Support Healthcare Provider + CCM - Certified Case Manager (certification may be required… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …evaluates, coordinates, and monitors activities and operations related to organizational regulatory compliance efforts pertaining to coding and billing audits ... compliance of federal coding documentation requirements. + Participates in outside healthcare compliance organizations to stay abreast of compliance … more
- Molina Healthcare (New York, NY)
- …Public Health, Social Work, or related field. **Required Experience** + 5+ years of managed healthcare experience, including 3 or more years in one or more ... **Preferred Experience** + 3+ years supervisory/management experience in a managed healthcare environment. + Medicaid/Medicare Population experience with… more
- LA Care Health Plan (Los Angeles, CA)
- … Regulatory Operations Project Manager II manages a portfolio of complex regulatory change management and compliance projects. This position will develop and ... drives continued progress for project success; develops strategies for achieving compliance with state and federal regulatory , contractual and accreditation… more
- Robert Half (Boston, MA)
- JOB REQUISITION Risk and Compliance - Healthcare - Senior Manager LOCATION BOSTON ADDITIONAL LOCATION(S) NEW YORK CITY, SAN FRANCISCO, SEATTLE JOB DESCRIPTION ... Need You Protiviti is looking for a Risk and Compliance Senior Manager to join our growing Healthcare...of commonly used internal control frameworks, risk frameworks and regulatory / compliance methodologies. + Expertise of risk assessment… more
- Robert Half (Boston, MA)
- JOB REQUISITION Risk and Compliance - Healthcare Industry, Senior Consultant 2 LOCATION BOSTON ADDITIONAL LOCATION(S) NEW YORK CITY, SAN FRANCISCO, SEATTLE JOB ... Need You Protiviti is looking for a Risk and Compliance Senior Consultant to join our growing Healthcare...of commonly used internal control frameworks, risk frameworks and regulatory / compliance methodologies . + Expertise of risk… more
- Aveanna (Atlanta, GA)
- Director, Regulatory Licensing ApplyRefer a FriendBack Job Details Requisition #: 194333 Location: Atlanta, GA 30339 Category: Management Salary: Starting at ... you passionate about making a difference in people's lives through superior home healthcare ? Look no further! Aveanna Healthcare is seeking dedicated individuals… more
- Robert Half Legal (Rancho Cucamonga, CA)
- …team and become a Managed Care expert (MediCare). You will advise on regulatory and compliance issues, and a critical HIPAA advisor. The company is subject ... executive briefings for leadership. + Be a Subject Matter Expert & Trust Managed Healthcare Advisor: Attend meetings with different business units, analyze legal… more
- Molina Healthcare (Columbus, OH)
- …Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of ... and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist, Quality Interventions /… more
- Molina Healthcare (West Seattle, WA)
- …Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of ... direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. Experience with QUALITY/HEDIS is important for this position.… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a Senior Counsel, Managed Care? At HCA Healthcare , you come first. HCA Healthcare has committed ... regarding managed care payor agreements (including drafting language, identifying regulatory issues, and assisting with related operational issues on behalf of… more
- Molina Healthcare (Las Vegas, NV)
- …network development and management, or project management experience in a managed healthcare setting. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : ... experience in a managed care setting. * 3+ years experience in managed healthcare administration and/or Provider Services. * Working familiarity with various… more
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