- Banner Health (AR)
- …accordingly in a timely fashion. + Working in start-up environment + Medicare Advantage Compliance training, audits, regulations, and manuals. + Reviewing ... knowledge of laws and regulations pertaining to health care, regulatory compliance , Medicare /Medicaid and/or financial reimbursement systems. Must possess strong… more
- Robert Half (Boston, MA)
- …global consulting firm. Where We Need You Protiviti is looking for a Risk and Compliance Senior Consultant to join our growing Healthcare team. What You ... REQUISITION Risk and Compliance - Healthcare Industry, Senior Consultant 2 LOCATION BOSTON ADDITIONAL LOCATION(S)...healthcare payer regulations and guidance with emphasis on the Medicare Managed Care Manual. + Expertise of core business… more
- Guidehouse (Philadelphia, PA)
- …Public Trust **What You Will Do** **:** Guidehouse is looking for a Senior Consultant to work on a Centers for Medicare and Medicaid Services (CMS) project ... CMS programs, specific to the Affordable Care Act. The Senior Consultant will work with a team...3 - 5 years of professional experience in audit, compliance , research, program management, process improvement, or operations +… more
- MyFlorida (Tallahassee, FL)
- …supervision for the SHINE (Serving Health Insurance Needs of Elders) program, SMP ( Senior Medicare Patrol) Program, MIPPA ( Medicare Improvement for Patients ... OPERATIONS & MGMT CONSULTANT MGR - SES - 65000081 Date: Oct...in SHINE, SMP, and MIPPA to ensure the following: compliance with terms of contracts/agreements and the mission of… more
- Highmark Health (Columbus, OH)
- …programs and results to key provider partners. + Collaborate with and support the senior Strategic Partners Consultant role as needed + Other duties as assigned ... integration into the overall Enterprise strategy through collaboration with Senior -level internal/external stakeholders. Ensures a high degree of development,… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Senior Reimbursement-Chargemaster Analyst-Chargemaster/Projects -REMOTE** The Senior Reimbursement and Chargemaster Analyst is reporting to ... charge description master including updates, setting new charges, reviewing for compliance , and making recommendations for optimizing reimbursement as well as… more
- ChenMed (Detroit, MI)
- …mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to be ... position towards becoming a center clinical P&L leader (ie, Senior Medical Director [SMD]) in the organization. The incumbent...Act as a health coach, rather than just a consultant for sickness, by helping patients set short and… more
- Cleveland Clinic (Port Saint Lucie, FL)
- Senior SQPE Specialist Directs safety, quality, and experience work across an Enterprise service line or submarket demonstrating expert-level competencies in several ... and behavioral standards. Coordinates with cross functional stakeholders to ensure compliance with all standards and favorable performance on safety, quality,… more
- Medical Mutual of Ohio (OH)
- …and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Responsibilities** **Provider ... assisting with analyses, projects, etc. Supports negotiation and contract interpretation and compliance . . Work on various special projects and ad-hoc reports on an… more
- Kedrion Biopharma, Inc. (Fort Lee, NJ)
- …be the key business partner to external third-party pricing and rebate consultant . He/she will deliver high quality Net Sales financial planning (including ... within his/her area, working alongside KBI FP&A Manager, Melville Plant Controller, Senior Accounting Manager, Senior Manager Treasury & KBI Sales Director… more
- CenterWell (Jackson, MS)
- …Care Organization is one of the largest and fastest growing value-based care, senior -focused primary care providers in the country, operating over 200 centers across ... care team supporting patient's physical, emotional, and social wellness. At CenterWell Senior Primary Care we want to help those in the communities we… more
- CenterWell (Dallas, TX)
- …other providers to form a narrow network of quality service focused on senior population health + Responsible for medical interpretation, reviews, and decisions as ... the organization in community and marketing events. + Develop and maintain compliance with the departmental and physician budgets. + Assess, develop and recommend… more
- Daiichi Sankyo Inc. (Basking Ridge, NJ)
- …but not limited to, areas of GPO/PBM and trade/distribution agreements, Medicare , Medicaid, product pricing, and government price reporting. Coordination with, and ... of Company and/or departmental expectations and goals as identified by senior management. **Responsibilities** - Lead drafting and negotiating contracts for… more
- The Joint Commission (Oakbrook Terrace, IL)
- …from the field, analysis of periodic performance reviews, evidence of standards compliance reports, complaints, and Medicare out-of- compliance reports. 4. ... health care setting(s), and 2 years of accreditation or certification leadership or senior management experience. Recent experience as a consultant to health… more
- Geisinger (Danville, PA)
- Job Summary Serves as a supportive consultant and educator to staff and administration for related reimbursement, strategic savings initiatives and coding ... compliance issues. Assists in assessing existing and prospective reimbursement...contracted providers, hospitals, etc. + Develops and maintains quarterly Medicare fee schedules. + Develops and maintains current percentage… more
- Spaulding Rehabilitation (Charlestown, MA)
- …completeness and accuracy of medical record documentation for the purposes of ensuring compliance with Medicare , Medicaid (CMS) regulations and guidelines and to ... processes and works to achieve and maintain CDI and Compliance departmental goals. Under the direction of the Spaulding...of CDI reports including key CDI program metrics to senior management + Approve PTO requests, assuring adequate staff… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Senior Risk Manager (Registered Nurse) Full-Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's ... a Forbes "Best Employer" seven times. Position Summary: The senior risk manager is responsible for the facility's risk...Mode and Effects Analysis). + Acts as resource, internal consultant , and educator for patient safety/risk management issues. +… more
- The Joint Commission (Oakbrook Terrace, IL)
- …and inductive reasoning skills to determine health care organizations' degree of compliance with applicable standards and functionality of care delivery systems. + ... dialogues on standards based issues in health care in order to assess compliance and to identify opportunities for improving compliance . + Prepares management… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …and standard setting agencies. The Risk Manager performs as an internal compliance consultant by maintaining current knowledge of hospital regulations including ... level of quality care to the patients, ensuring regulatory compliance and mitigating malpractice risk through loss prevention. The...surveys by the Department of Public Health, Centers for Medicare and Medicaid Services and The Joint Commission. +… more
- ChenMed (Philadelphia, PA)
- …mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to be ... unit of our care model - the center. The Senior Medical Director (SMD) will partner with the Center...Act as a health coach, rather than just a consultant for sickness, by helping patients set short and… more