- Humana (Harrisburg, PA)
- …service should be authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which may include national clinical ... teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to… more
- UPMC (Pittsburgh, PA)
- …Plan has an exciting opportunity for a Quality Assurance Coordinator in the Medicare Sales Support department. This is a full time position working Monday through ... Friday daylight hours and will be a remote position. Support the Medicare Sales Contact Center to increase sales and achieve business objectives while ensuring… more
- CVS Health (Harrisburg, PA)
- …processes, procedures, and systems to ensure consistent results and organizational compliance with regulations related to the organization's Medicare Part ... the implementation of business projects and programs and managing operations within the Medicare Part B Pharmacy Team. You will act as a Subject Matter Expert… more
- BAYADA Home Health Care (Philadelphia, PA)
- …supervision and support to field RNs, LPNs, and clinical staff + Ensure compliance with Medicare Conditions of Participation (CoPs), state regulations, and ... to fill the position of **Clinical RN Nurse Manager** for our **Philadelphia, PA** Medicare Certified, Home Health office. Do you want to be part of providing care… more
- Humana (Harrisburg, PA)
- …appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana ... experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Harrisburg, PA)
- …medical necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD represents ... experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- CVS Health (Harrisburg, PA)
- …with heart, each and every day. **Position Summary** Contributes to the Medicare Dental product portfolio, conducting market analysis and driving new product ... cross-functional collaboration. Drives innovation, evaluates performance, and ensures regulatory compliance , playing a pivotal role in guiding the organization's… more
- Prime Therapeutics (Harrisburg, PA)
- …specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid Services (CMS) compliance compliant + Utilize Prime's MTM ... operations (eg workflow processes and case management) + Government programs ( Medicare ) knowledge **Preferred Qualifications** + Contact Center experience + Pharmacy… more
- Gentiva (Pittsburgh, PA)
- …ensuring compliance with state, federal, and accreditation standards (CMS, Medicare , Joint Commission, etc.) + Provide clinical oversight and ensure timely and ... health, or healthcare operations leadership + Strong understanding of hospice regulations, compliance , and Medicare conditions of participation + Proven ability… more
- CenterWell (Lancaster, PA)
- …of third-party payers. Ensures final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team ... Interprets Company standards and Company policies and procedures to ensure compliance with external regulatory authorities and ensures that caregiver clinical… more