- BlueCross BlueShield of North Carolina (NC)
- **Job Description** The Compliance Advisor is responsible for performing day-to-day activities required to maintain an effective compliance program, ... compliance with new and existing laws, regulations, obligations, Medicare guidance and/or bid requirements as required of the...compliance reviews of marketing materials for commercial and/or Medicare lines of business. + When working with … more
- Mohawk Valley Health System (Utica, NY)
- …clinical variability throughout the medical staff. + Assist case managers with Medicare and Medicaid appeals and Administrative Law Judge (ALJ) testimonies. ... PHYSICIAN ADVISOR Department: CASE MANAGEMENT Job Summary The Physician... (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives, and quality patient… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …are seeking a physician with leadership experience interested in our new Physician Advisor position. 1. The Physician Advisor serves the Hospital through ... on matters regarding progression of patient care, medical necessity, compliance with regulatory guidelines, payer relationships; clinical documentation integrity,… more
- Penn Medicine (Philadelphia, PA)
- …letters for third party denials where appropriate * Apply the 2 midnight rule to Medicare reviews * Maintain compliance with Medicare rules as it applies ... shape our future each day. Are you living your life's work? The Physician Advisor is a key member of the healthcare organization's leadership team and is charged… more
- Nuvance Health (Danbury, CT)
- …committees to meet established goals for physician participation and compliance with expectations. *Responsibilities:* * Provides physician leadership for physician ... * Manages processes, policies, workflows and overall management of the physician advisor role within the organization. * Works to lead standardization of policy,… more
- UNC Health Care (Kinston, NC)
- …to overturn, proactively gathers required clinical documentation and formulates appropriate appeals . Coordinates with the Physician Advisor and Case management ... the Physician Advisors and subject matter experts for all audit and appeals work activities. Assists with documentation review to support the clinical documentation… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Medical Officer (ACMO) serves as a strategic clinical leader and trusted advisor , providing expert guidance across the organization and engaging with key external ... and regulatory requirements. * Provide clinical oversight for utilization management, appeals , and complex case reviews. * Participate in internal committees focused… more
- Huron Consulting Group (Chicago, IL)
- …Regulatory Oversight: Demonstrates knowledge of regulatory and accreditation requirements, ensuring compliance with Maryland state law, Medicare , Medicaid, and ... Tracking and Improvement: Provides analysis and reports of utilization, denials, and appeals KPIs, trends, patterns, and impacts to resources. Tracks, analyzes, and… more
- Sharp HealthCare (La Mesa, CA)
- …utilizing established criterion sets.The RN CM has accountability for maintaining compliance contractual and regulatory compliance with medical groups as ... Management.Assure correct documentation is present for 2MN benchmark and presumption.Assure Medicare Inpatient to observation status changes follow Condition Code 44… more
- Sharp HealthCare (San Diego, CA)
- …utilizing established criterion sets.The RN CM I has accountability for maintaining compliance contractual and regulatory compliance with medical groups as ... EMR.Assure correct documentation is present for 2MN benchmark and presumption.Assure Medicare Inpatient to observation status changes follow Condition Code 44… more
- University of Southern California (Arcadia, CA)
- …intervention based on department criteria. + Refers cases and issues to physician advisor in compliance with department procedures and follows up as indicated. ... cost per case, excess days, resource utilization, readmission rates, denials, and appeals . + Collaborates and communicates with multidisciplinary team in all phases… more