- Prime Therapeutics (Trenton, NJ)
- …lines of business (Employer Markets, Health Insurance Marketplace (HIM), Commercial, Medicare , and Medicaid). This individual is the primary relationship and ... Lead retention efforts for Employer Markets, Health Insurance Marketplace, Commercial, Medicare , and Medicaid health plan clients; drive the adoption and consistent… more
- Atlantic Health System (Morristown, NJ)
- Under the supervision of the Assistant General Counsel (ACG), review prepare and negotiate a full range of hospital contracts including, without limitation, ... issues, including fraud and abuse issues, HIPAA compliance, EMTALA, Medicare and Medicaid compliance, licensure issues, pay-to-play issues, corporate governance… more
- RWJBarnabas Health (Oceanport, NJ)
- …NY only The primary purpose of the Billing and Coding Analyst is to review , adjust, and report on clinical trial charges and claims representing research while ... ensuring research charges are collected and posted in accordance with Medicare s Clinical Trial Policy, federal regulations and pharmaceutical/third party contracts.… more
- Evolent (Trenton, NJ)
- …is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with ... Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization ...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- CVS Health (Trenton, NJ)
- …an Oncology RPh Advisor in Government Services you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy ... responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for… more
- Datavant (Trenton, NJ)
- …the application of learning to the work environment through various methods + Review client level audits and advise training content to re-educate team on coding ... and understanding of HCC mapping and models + Experience with coding Medicare , Commercial and Medicaid risk adjustment charts + Understanding of Medicare… more
- Prime Therapeutics (Trenton, NJ)
- …This role is dedicated to the government program compliance in the Medicare , Medicaid, and the Affordable Care Act (ACA) spaces. **Responsibilities** + Executes ... of interest or other cyclical compliance processes, or implementing a regular review cadence for standard operating procedures (SOP) and policies + Research and… more
- Evolent (Trenton, NJ)
- …provides clinical rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Trenton, NJ)
- …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more
- Evolent (Trenton, NJ)
- …provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more