- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …we need: As an integral part of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as ... escalate to senior leaders for decision making + Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity… more
- The Cigna Group (Bloomfield, CT)
- **Role Summary** The Medicare Part C Compliance Senior Manager is responsible for the design, implementation, and ongoing execution of the Medicare ... compliance program while upholding the overall Cigna Compliance Plan. This Senior Manager will ensure...Director of Medicare Business Support and the Medicare Compliance Officer of Part C trends,… more
- The Cigna Group (Bloomfield, CT)
- …medical equipment and out of network services. Conduct reviews in compliance with medical policy, member eligibility, benefits, and contracts. **Essential Duties ... medical necessity and appropriateness of setting according to established policies and compliance guidelines. + Uses an established set of criteria to evaluates and… more
- CVS Health (Fresno, CA)
- …report and recommend solutions. Independently coaches others on appeals ensuring compliance with Federal and/or State regulations. Manage control and trend ... the appeal if there is an inquiry from leadership, compliance and State regulators. Understand and adapt to departmental...regulators. Understand and adapt to departmental process and policies. Medicare knowledge is a plus. Fast Turn Around of… more
- BrightSpring Health Services (Arlington, TX)
- …focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacyenvironment. Our organization is inhigh ... calls/claims per hour as determined by the Director and Clinical Hub Manager + Provide clinical support...Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and State Laws, and applicable… more
- University of Maryland, Baltimore (Baltimore, MD)
- *The University of Maryland Baltimore has an exciting opportunity**for a Senior Clinical and Corporate Resource & Budget Management Associate (CCT Admin Budget ... **Reg or CII Exempt Staff* **Organization:** **Research and Development - Center for Clinical Trials* **Title:** * Senior Clinical & Corporate Contracts… more
- University of Maryland, Baltimore (Baltimore, MD)
- *The University of Maryland, Baltimore*(UMB) is seeking a*Corporate & Clinical Trials Contracts Senior Associate* in the Center for Clinical Trials and ... clinical and/or corporate contracts and collaboration agreements in compliance with sponsor, federal, state and university policies and regulations. Familiarity… more
- Ellis Medicine (Schenectady, NY)
- BASIC FUNCTION: The Clinical Resource Coordinator functions as the clinical nurse manager and oversight Ellis Medical Group Outpatient Practice location(s) (as ... care delivery to ensure efficient and effective patient care. Responsible for compliance with departmental and regulatory standards of care and practice. In… more
- Option Care Health (Chicago, IL)
- …vaccinated, or your employment will be terminated. **Job Description Summary:** The Senior Manager, Compliance Auditing, Monitoring and Analytics is responsible ... and abuse, including but not limited to HIPAA, Anti-Kickback, Stark, Medicare /Medicaid reimbursement. Experience evaluating information to determine compliance … more
- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** The Senior Quality Compliance Nurse Professional is an integral part of the Oklahoma ... goals and complete time sensitive deliverables for Quality Improvement clinical and non- clinical performance projects. The role...role operates as a subject matter expert in Quality Compliance . The Senior Quality Compliance … more
- Rush University Medical Center (Chicago, IL)
- …5:00:00 PM) **Summary:** This position will create coverage analyses in accordance with Medicare 's Clinical Trial Policy (NCD 310.1) and assist research staff ... provide high-level professional support in the growing efforts to conduct prospective Medicare Coverage Analysis for all clinical research studies. Exemplifies… more
- Rush University Medical Center (Chicago, IL)
- …Research Revenue Cycle, this position will create coverage analyses in accordance with Medicare 's Clinical Trial Policy (NCD 310.1) and assist research staff ... provide high-level professional support in the growing efforts to conduct prospective Medicare Coverage Analysis for all clinical research studies. Exemplifies… more
- The Mount Sinai Health System (New York, NY)
- …and contract compliance related to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as MSHP's subject ... within Mount Sinai. The team includes 400+ employees with clinical , contracting, finance, IT, analytics, operations, and product development expertise.… more
- Scripps Health (San Diego, CA)
- …our employees have been with Scripps Health for over 10 years. The Chargemaster Senior Analyst provides assistance and analysis to all levels of clinical ... and researches and communicates coverage guidelines for billable services. Works with clinical directors and managers to implement and monitor CDM changes. Provides… more
- University of Michigan (Ann Arbor, MI)
- Reimbursement Analyst Senior Apply Now **How to Apply** A cover letter is required for consideration for this position, and it should be attached as the first page ... and government entities. The reimbursement analyst will maintain current knowledge of Medicare , Medicaid and other State and Federal regulations. The analyst also… more
- Bristol Myers Squibb (Boston, MA)
- …. Reporting into the Medical Value Liaison Field Director, the Senior Medical Value Liaison (MVL)/Executive MVL is a field-based role focused ... on applying clinical expertise and experience/knowledge of payors, health policy, payer...policy makers, and other decision makers and influencers. **Responsibilities** ** Senior Medical Value Liaison** + Provide comprehensive, accurate, fair,… more
- AdventHealth (Orlando, FL)
- **AdventHealth HIM Coding** ** Senior Medical Coder - Inpatient Coding Specialist** **All the benefits and perks you need for you and your family:** . Paid Parental ... The Inpatient Coder is responsible for reviewing, analyzing, and interpreting clinical documentation in the medical record, applying appropriate ICD-10-CM/PCS coding… more
- Rush University Medical Center (Chicago, IL)
- …requirements specific to Research Billing. * Maintain a detailed understanding of Medicare 's Clinical Trial Policy (NCD 310.1) and related guidance documents. ... Responsible for managing, reconciling and invoicing all revenue secured by Clinical Trials Research Revenue Cycle, work closely with operations, sponsors, and… more
- Beth Israel Lahey Health (Boston, MA)
- …of America) Under the general direction of the Associate Director of the Clinical Trials Office (CTO), the Senior Contracting Specialist works with ... clinical research. + Understands and keeps current with FDA and Medicare regulations applicable to clinical trials. Implements rules, regulations, guidelines… more
- Aveanna (Grand Rapids, MN)
- …RN Clinical new hires * Provides ongoing training and educational opportunities for Clinical staff * Serves as a senior member to all staff regarding quality ... Home Health RN Assistant Clinical Manager ApplyRefer a FriendBack Job Details Requisition...agency policy and procedures and state/federal regulation * Ensures compliance with regulations and is available for federal and… more