- Highmark Health (Buffalo, NY)
- …are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with ... STARS, Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the needs… more
- OhioHealth (Columbus, OH)
- …Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position ... will be responsible for ensuring the appropriate governmental ( Medicare and Medicaid) reimbursement is received for OhioHealth. * This position is primarily… more
- Henry Ford Health System (Traverse City, MI)
- …and planning and marketing support. Coordinate the development and implementation of Medicare Advantage sales strategies, compliance activities and oversight for ... SUMMARY: Responsible for the retention and growth of the Medicare line of business (both Individual and Group) accounting...years of successful health insurance sales experience in the Medicare market. + Minimum of three (3) years of… more
- Baylor Scott & White Health (Nashville, TN)
- **Description - External** **JOB SUMMARY** The Healthcare Billing Compliance Consultant Sr performs ongoing activities related to the development, ... maintenance of, and adherence to established policies and procedures in compliance with federal, state, and local laws and regulations. **SALARY** The… more
- Elevance Health (Tampa, FL)
- **Medical Director- Florida Medicare Plans** Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... Tampa locations.** The **Medical Director** will support the following Florida Medicare plans: Simply Healthcare Plans, Healthsun Plans, Freedom Health, and Optimum… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross and Blue Shield of Minnesota Position Title: Senior Policy Consultant Location: Hybrid | Eagan, Minnesota Career Area: Corporate Affairs About Blue ... You Will Have Blue Cross Blue Shield MN is looking for a Senior Policy Consultant to join our team. This position is responsible for serving as the principal policy… more
- MyFlorida (Fort Myers, FL)
- GOVERNMENT OPERATIONS CONSULTANT II - 64082631 1 1 Date: Jan 6, 2026 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... . Requisition No: 867662 Agency: Department of Health Working Title: GOVERNMENT OPERATIONS CONSULTANT II - 64082631 1 1 Pay Plan: Career Service Position Number:… more
- TEKsystems (Chula Vista, CA)
- I Consultant - Conversational AI (Healthcare) Contract Role | Conversational AI | Healthcare Technology About the Organization A mission-driven, nonprofit healthcare ... organization serving Medicaid and Medicare populations is investing heavily in next‑generation artificial intelligence....ecosystem. Role Overview We are seeking an experienced AI Consultant specializing in Conversational AI to design, build, and… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Cross and Blue Shield of Minnesota Position Title: Risk Adjustment QA Consultant Location: Hybrid | Eagan, Minnesota Career Area: Customer Service/Operations About ... Will Have As a Risk Adjustment Quality Assurance (QA) Consultant at BCBSMN, you'll play a critical role in...a critical role in ensuring the accuracy, completeness, and compliance of risk adjustment coding across both internal teams… more
- Elevance Health (Atlanta, GA)
- **JR176174 Proposal Development Consultant ** The Proposal Development Consultant plays a key role in leading the proposal lifecycle by driving complex RFIs and ... client needs, and support organizational growth objectives. The Proposal Development Consultant is responsible for understanding and leading the proposal process and… more
- Oracle (Austin, TX)
- …and contribute to project teams. Requirement analysis, problem-solving, and ensuring compliance with company policies and procedures. Analyze business needs to ... solutions for each healthcare payer. An Oracle Health Insurance (OHI) Senior Principal Consultant must be proficient in US healthcare domain knowledge and have the… more
- HCA Healthcare (Overland Park, KS)
- … with accreditation and regulatory requirements (Joint Commission, Medicare /Medicaid, state standards) and maintaining required documentation + Partnering ... have the career opportunities as a(an) PRN RN Lactation Consultant you want with your current employer? We have...you want to work as a(an) PRN RN Lactation Consultant where your passion for creating positive patient interactions… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** This Senior Consultant , Enterprise Rule & Edits position reports to our Enterprise Rules & Edits Manager and has the responsibility for ... active involvement in scoping, project planning, implementation, and stabilization. The Consultant will leverage billing and coding subject matter expertise and… more
- HCA Healthcare (Fort Walton Beach, FL)
- … with accreditation and regulatory requirements (Joint Commission, Medicare /Medicaid, state standards) and maintaining required documentation + Partnering ... about delivering patient-centered care?** Submit your application for Registered Nurse Lactation Consultant position and spend more time at the bedside with the… more
- The County of Los Angeles (Los Angeles, CA)
- HEALTH FACILITIES CONSULTANT , NURSING Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2307969) Apply HEALTH FACILITIES CONSULTANT , NURSING ... nursing facilities, and related health facilities to assist them in achieving compliance with State and Federal nursing regulations, and with the professional staff… more
- Signature Healthcare (Winchester, KY)
- …of choice in the healthcare industry. Overview The ideal Signature Clinical Care Consultant Candidate would have working knowledge of Medicare , Medicaid and ... standards of care are in place to achieve clinical, regulatory, and reimbursement compliance . + Provide oversight and guidance to staff in assigned facilities, which… more
- WellSense (NH)
- …for our members, no matter their circumstances. **Job Summary:** The Provider Relations Consultant - NH will act as the primary liaison between Provider Relations ... provider education, servicing, credentialing and recruitment . Ensures quality and compliance with State Agencies and NCQA . Other responsibilities as assigned… more
- HCA Healthcare (Houston, TX)
- … with accreditation and regulatory requirements (Joint Commission, Medicare /Medicaid, state standards) and maintaining required documentation + Partnering ... about delivering patient-centered care?** Submit your application for Lactation Consultant RN PRN position and spend more time at...your career! We are interviewing candidates for our Lactation Consultant RN PRN opening. **Apply today and a member… more
- WellSense (MA)
- …and administering contractual provisions of provider agreement to ensure contractual compliance ** . **Manages flow of information to and from provider offices** ... in community outreach activities and events** . **Ensures quality and compliance with state Medicaid regulations and NCQA requirements** . **Other responsibilities… more
- US Tech Solutions (RI)
- …to obtain additional information. + Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines. + ... Medcompass + Must have prior authorization utilization experience. + Managed Care/ Medicare experience preferred. **Skills:** + MUST HAVE MEDCOMPASS or ASSURECARE… more
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