- Healthfirst (NY)
- …Leads or participates in product -driven workgroups, to provide input to product designs/enhancements and implementation plans + Works with key stakeholders ... identify, scope and accurately implement new benefits, services, or other product changes, update processes and/or edit systems to accommodate regulatory… more
- Trinity Health (Syracuse, NY)
- …Office CDM and Compliance team. Ensures CDM codes are compliant with Medicare and local payer guidelines. Works with various clinical departments and physicians ... root cause analysis on issues with pre-billing and identifies opportunities for optimization of revenue. May be responsible for local pricing decisions. Required to… more
- Houston Methodist (Houston, TX)
- …and management across HM organizations. + Coordinates with IT to ensure the implementation and optimization of processes that support the clinical research ... criteria for qualifying clinical trials as defined by the Medicare Clinical Trial Policy (NCD 310.1) and will also...solutions that support clinical research activities which include the implementation and optimization of the financial modules… more
- Independent Health (Buffalo, NY)
- …improvement in quality of care and health outcomes as measured by HEDIS, Medicare Star, and QARR, including parameters that reflect the organization's health equity ... accountable for compilation and submission of key quality performance requirements for Medicare Star, Medicaid QARR, and Commercial NCQA HEDIS and CAHPS reporting.… more
- LA Care Health Plan (Los Angeles, CA)
- …federal, state, and industry-specific regulatory requirements, driving process optimization , and enhancing the organization's compliance framework. The Regulatory ... regulations. Provides expert advice to various teams, including program and product development, marketing, and customer service, on various relevant topics. Duties… more
- The Cigna Group (Bloomfield, CT)
- …upsell services to grow the business. Cross functional teams include Product Management, Sales Enablement, Finance, Regulated Markets, Implementation , ... Sr. Account Executive is responsible for planning, internal coordination, implementation , maintenance, and communication of client strategic and financial activities… more
- Houston Methodist (The Woodlands, TX)
- …to enhance consistent clinical, service and financial outcomes through the implementation of exemplar practice. This position provides leadership and direction to ... discharge planning, progression of care, documentation of improvement, and Medicare Conditions of Participation. **QUALITY/SAFETY ESSENTIAL FUNCTIONS** + Ensures a… more
- UPMC (Pittsburgh, PA)
- …such as prior authorization, step therapy, quantity level limits, and other dose optimization techniques. + (2) Product Development Managed care residency or 1-3 ... Clinical Pharmacy Specialist provides clinical pharmacy expertise to the development, implementation and management of the pharmacy benefit. The clinical pharmacist… more
- Mitsubishi Chemical Group (Jersey City, NJ)
- …providing strategic recommendations to senior leadership and overseeing strategy implementation with the Payer & Trade Accounts. **Responsibilities** Strategic ... providing insights to guide business decisions. + Lead the development and optimization of distribution strategies for both new and existing products in response… more