- Molina Healthcare (Albany, NY)
- …appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) ... knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and… more
- BlackRock (New York, NY)
- …be able to effectively manage compliance risk and help ensure compliance with regulatory requirements and applicable BlackRock policies and procedures ... for new product development and implementation of new regulations + Implement compliance programs/control frameworks relevant to regulatory risks and legal… more
- Stantec (New York, NY)
- …transit systems, water treatment facilities, mines, and wind farms, we've successfully managed thousands of projects. Joining our team, turning visionary ideas into ... the Project Manager level, to manage projects on behalf of owners in the healthcare sector. The projects located in Central and Eastern Long Island, are in various… more
- Molina Healthcare (Buffalo, NY)
- …opportunities for improvement of member outcomes + Oversees and ensures compliance with contractual, accreditation and regulatory requirements relative to ... **Job Description** **Job Summary** Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and… more
- Robert Half (New York, NY)
- …to financial crime and anti-money laundering, risk management, credit services, regulatory compliance , consumer protection, and analytics. Meaningful onboarding. ... JOB REQUISITION New York City Risk and Compliance Consultant - 2026 LOCATION NEW YORK CITY...for medical, dental, and vision coverages, FSA and HSA healthcare accounts, life and accident insurance, adoption and fertility… more
- Guidehouse (New York, NY)
- **Job Family** **:** Risk & Regulatory Compliance Consulting **Travel Required** **:** Up to 50% **Clearance Required** **:** None **What You Will Do:** ... consulting firm serving the public and commercial markets in financial services, healthcare , sustainability, and national defense. Our mission is to help clients… more
- Molina Healthcare (Buffalo, NY)
- …that would affect job performance. **Preferred Experience** + 5 years in the healthcare industry, managed care organization or equivalent experience. + Knowledge ... team, assisting the team in understanding pharmacy quality, cost effectiveness and compliance and working closely with the Pharmacy Director or AVP to ensure… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …travel required **Scope of Responsibilities:** Oversight responsibility for the managed care department of the company. Responsible for training, development ... favorable contract outcomes and resolve disputes efficiently. + Monitor contract compliance , escalate disputes, and drive resolution of reimbursement issues. + Work… more
- Catholic Health Services (Melville, NY)
- …Attends meetings as required and participates on committees as directed. Identifies managed care/ regulatory issues/ compliance contributing to denial activity ... Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named...Catholic Health Physician Advisor when appropriate. Reviews results from managed care payors and/or regulatory agencies determinations… more
- Humana (Albany, NY)
- …site of service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include ... medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements,… more
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