- CVS Health (Harrisburg, PA)
- …The Medicare Grievance Sr. Coordinator will fully research and resolve beneficiary complaints. Candidates can live anywhere US These complaints can include various ... issues and may require coordination with various departments to fully reach resolution. Responses must be timely and include member focused solutions in both written and oral format. Ideal candidates will have Medicare knowledge, customer service experience,… more
- UT Health (Houston, TX)
- Remote Senior Compliance Coding Analyst - Emergency Medicine **Location:** Texas Medical Center-Houston, Texas **Hot** **Category:** Legal McGovern Medical School at ... reviews of medical/patient records to ensure provider billing practices are compliant with applicable rules and regulations. Serves as a knowledge resource… more
- Mitsubishi Chemical Group (Jersey City, NJ)
- …real-world evidence, and creating hope for all facing illness. The Senior Manager, Incentive Compensation is responsible for planning, developing, and implementing ... within the organization. **Responsibilities** + In close collaboration with senior Commercial leaders, design, support, and administer Incentive Compensation plans… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Senior Contract Specialist works closely with Corporate Governance (Legal), Government Affairs, Product, Marketing, Mandates, ... Insurance Administration surveys as needed and assigned. Responds to Central Appeals Unit, Executive Inquiry, Corporate Audit and other department inquiries that… more
- Medtronic (Fridley, MN)
- …and State Audit IDRs and proposed adjustments, as well as supporting responses on appeals and litigation related business unit tax matters. * Assist other OU Tax ... nationally (except in certain CA locations). The rate offered is compliant with federal/local regulations and may vary by experience, certification/education, market… more
- State of Colorado (Denver, CO)
- …Communications Division works closely with division directors, managers, supervisors, and senior leadership. This unit also works closely with the Governor's Office ... ensure sufficient content is obtained, articles are well-written and compliant with AP and BHA style and the newsletter...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Honeywell (Charlotte, NC)
- Senior Benefits Analyst, H&I Active/Retiree and Non-Core We are looking for an experienced, data-driven Sr. Benefits Analyst to be responsible for the administration ... to the success and effectiveness of Honeywell's overall operations. Ensure operations are compliant with current government law and regulations in the US and Puerto… more
- State of Colorado (Limon, CO)
- …inmate work crews in laundry operations and ensuring the safe, efficient and compliant completion of assigned tasks. This position promotes the CDOC Mission and ... absence of another supervisor. Operations- Position maintains safe, secure and compliant laundry operations and equipment maintenance; prepares daily weight records,… more
- State of Colorado (Denver, CO)
- …and in team situations, and exhibit honesty, integrity, and accountability. This senior position will work with and help lead cybersecurity and physical security ... others doing substantially similar work. While all offers are compliant with the Colorado Equal Pay for Equal Work...of the department's action. For more information about the appeals process, the official appeal form, and how to… 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
- Harvard University (Cambridge, MA)
- …count toward education. 5 or more years providing support to senior /executive-level staff with increasing levels of responsibility and independence. Additional ... looking to learn more about why this role specifically appeals to you, and what in your background (your...close partnership with the Administrative Coordinator who supports other senior leaders in the Dean's office and with the… 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
- 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
- Nuvance Health (Danbury, CT)
- …information into the tracking software, providing supporting documentation, generating appeals , and complying with all government regulatory requirements to satisfy ... by coordinating efforts to satisfy audit requirements and provide analysis to senior revenue cycle leadership on preventive measures to reduce audits. 5.Confirm the… 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
- AbbVie (Troy, MI)
- …in medical policy, Prior Authorization requirements, or product acquisition. Apply compliant methods to exchange critical information + Work collaboratively and ... (Market Access, Center of Excellence, Sales, Marketing, Trade, Specialty Pharmacy, Senior Leadership) + Educate accounts on need-based tools to support patient… more
- Amgen (Roanoke, VA)
- …to reach difficult to access health care providers and accounts in a compliant manner + Channel patients to treatment: Creating referral networks to both existing ... treatment CoEs. + Building long-term relationships across multiple stakeholders and senior decision-makers, both inside and outside of Amgen, and sustaining… 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
- San Jose State University (San Jose, CA)
- …to the President, the Vice President for Strategy & Chief of Staff, and other senior administrators on the university's Title IX and DHR program. + Develop and lead ... for investigations, hearings, determinations of responsibility, disciplinary sanctions, remedies, appeals , informal resolution outcomes, supportive measures, and materials used… more