- OhioHealth (Marion, OH)
- …Verifies and documents expirable using acceptable verification sources to ensure compliance with accreditation and regulatory standards. Performs detailed and ... governing documents (bylaws/rules and regulations/policies and procedures) to ensure continuous compliance . Participates in surveys and audits of regulatory and… more
- Prime Therapeutics (Columbus, OH)
- …(corporate governance, dispute resolution, contract negotiation, employment law, audits/investigations, regulatory compliance ) + 3 years of experience advising ... visa or residency sponsorship **Additional Qualifications** + Advanced knowledge of PBM regulatory frameworks and healthcare law, with demonstrated ability to… more
- Humana (Columbus, OH)
- …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
- Humana (Columbus, OH)
- …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 ... on various behavioral health topics to the clinical operations team and healthcare organization. The Medical Director's work includes computer based review of… more
- Trinity Health (Columbus, OH)
- …**MOUNT CARMEL HEALTH SYSTEM** Mount Carmel Health System (MCHS) looks at healthcare differently. Beyond providing exceptional and advanced care when people need us ... performance in alternative payment models. Collaborates with MCHS and Trintiy Health managed care teams on APM contracting. Attends Board meetings and reports… more
- CVS Health (Columbus, OH)
- …calls, researching information, and assisting in solving problems. + Adheres to compliance with policies and regulatory standards. + Maintains accurate and ... not limited to, privacy and confidentiality, quality management processes in compliance with regulatory , accreditation guidelines, company policies and… more
- CenterWell (Columbus, OH)
- …The Medicaid Drug Strategy Pharmacist Lead requires a broad understanding of pharmacy, managed care, PBM, market and regulatory insights to develop, and/or ... lines of business. + Utilizes broad understanding of pharmacy, managed care, PBM, market and regulatory insights...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- Humana (Columbus, OH)
- …Implement process improvements to enhance data accuracy, reporting efficiency, and compliance with regulatory requirements, ensuring continuous improvement and ... opportunity for a motivated individual to influence the mission of a leading healthcare company committed to improving the health of the communities it serves.… more
- Elevance Health (Mason, OH)
- …and procedures. + Within the medical management role will collaborate with healthcare providers and members to promote quality member outcomes, to optimize member ... applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs… more
- Humana (Columbus, OH)
- …for the Medicaid line of business. + Utilizes broad understanding of pharmacy, managed care, PBM, market and regulatory insights to support the implementation ... us put health first** The Senior Professional collaborates with healthcare professionals, pharmacists, and other business functions to implement...degree or equivalent + 3+ years of experience in managed care or other pharmacy related field + 3+… more