- Commonwealth Care Alliance (Boston, MA)
- …clinical, operations, pharmacy, dental, reporting, and member services. - Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day ... **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department...and courteous member communication and that the organization is compliant and meeting all strict deadlines. - When necessary… more
- MyFlorida (West Palm Beach, FL)
- SENIOR LEGAL ASSISTANT - SES - 64080098 Date: Sep 16, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... Requisition No: 837301 Agency: Department of Health Working Title: SENIOR LEGAL ASSISTANT - SES - 64080098 Pay Plan:...County Environmental Control Hearing Board (ECHB) and the Environmental Appeals Board (EAB). The cases heard before the ECHB… more
- Magellan Health Services (Albuquerque, NM)
- …and Commercial) and implements and manages programs to support this vision. The Senior Medical Director ensures the delivery of appropriate health care by overseeing ... policies of the company are consistently implemented and NCQA and/or URAC compliant . Analyzes utilization, quality, and financial data to ensure high quality and… more
- University of Michigan (Ann Arbor, MI)
- Allied Health Senior Supr Apply Now **What You'll Do** **Personnel and Operations Management:** + Administrative and direct supervision, including hiring, ... are utilizing the correct codes and that charges are compliant . + Develops policies, processes and procedures for the...processes and procedures for the management of write-offs and appeals and trains all scheduling staff on updates to… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** This Senior Regulatory Compliance Analyst position will conduct independent data mining, analysis and reporting. Participate ... presence of risks and trends within systems and processes that may be non- compliant with contracts and or statutory requirements especially in the claims processing,… more
- Indy Gov (Indianapolis, IN)
- …County agencies, officials, and oversight bodies to ensure that public entities remain compliant with the law and standards of ethical conduct, to safeguard public ... exercising these crucial legal functions, OCC cultivates a productive, collaborative, and compliant work environment that prioritizes the needs of our clients and… more
- State of Colorado (Limon, CO)
- …inmate work crew in laundry operations and ensuring the safe, efficient and compliant completion of assigned tasks. This position promotes the CDOC Mission and ... inmates for community reentry. Operations- Position maintains safe, secure and compliant laundry operations and equipment maintenance; prepares daily weight records,… more
- University of Utah (Salt Lake City, UT)
- …in consultation with fellow managers + Develops and manages effective and compliant training programs for staff; Conducts general or specialized training sessions; ... in thorough, accurate, and timely responses + Applies verification and appeals policies/requirements accurately, consistently, fairly, and equitably + Monitors and… more
- State of Colorado (CO)
- …other related human resources policies to ensure that wellness initiatives are compliant and effective; + Respond to routine inquiries related to wellness programs ... support networks, and program eligibility; refer complex matters to senior management or legal advisors as necessary; + Collect...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Pueblo, CO)
- …for policy issues that may impact current program design; coordinating at the senior management level the development of the Division strategic plan for the ... are implemented and maintained + Ensures PRC is regulatorily compliant and survey-ready + Works directly with Division and...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Magellan Health Services (Honolulu, HI)
- …case management. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... for NCQA and URAC certifications. Develops and provides leadership for NCQA- compliant clinical quality improvement activity (QIA) in collaboration with the clinical… more
- State of Colorado (Denver, CO)
- …administration for the Department and serves as a member of the Department's Senior Staff. This position oversees a variety of administrative projects, including the ... system and post the most current version. + Assure documents are compliant with accessibility standards and requirements. + Interpret and incorporate policies and… more
- Dollar Tree (Chesapeake, VA)
- The Vice President of Tax is the most senior position in the tax group and is responsible for creating and driving the overall tax strategy of Dollar Tree Inc. and ... leadership regarding DTI's intercompany accounting charges to ensure they are compliant with the appropriate transfer pricing rules. **Tax Compliance** + Manage… more
- Fallon Health (Worcester, MA)
- …Program Manager, Accreditation & Audit ensures that the health plan is compliant with the National Committee for Quality Assurance standards, the regulations ... regulatory environment to promote awareness with other directors and senior leaders of the health plan the impact of...audit activities + Ensures that the health plan is compliant with NCQA, CMS, EOHHS. Manages the process of… more
- The Cigna Group (Franklin, TN)
- …+ Responsible for development of clinical policy, clinical review decisions, appeals , audits, and other clinical functions, supported by program clinical leaders, ... care delivery teams that prioritize high quality, safe and compliant operations within the Healthcare Sector **Competencies for Success**...on par with what is expected for presentations to senior leaders + The ability to influence others through… more
- LA Care Health Plan (Los Angeles, CA)
- …Summary The Compliance Advisor II ensures LA Care business units are compliant with all Product Lines' contractual, state and federal regulatory, and accreditation ... setting. Experience in health care auditing and monitoring (preferably in Appeals , Grievances, Quality Improvement, Utilization Management (UM) and so forth) and… more