- City of New York (New York, NY)
- …and Referral System NYC CI&R) we are streaming the manner in which clinical and community-based providers can connect their families to home visiting services. A ... develop metrics to measure success and outcomes. Support and collaborate with the Research and evaluation Unit on program evaluation and preparation of reports and… more
- Elevance Health (Indianapolis, IN)
- …medical policies, reimbursement policies, and editing rules, as well as conducting clinical research , data analysis, and identification of legislative mandates ... of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.** PRIMARY… more
- BrightSpring Health Services (Lansing, MI)
- …should focus on delivering high-quality therapy, so we provide exceptional administrative and clinical support to make your job easier and more fulfilling. Our BCBAs ... reimbursement for graduate or professional degrees + Opportunities to participate in research projects and present at conferences + Internal growth opportunities and… more
- Fairview Health Services (Minneapolis, MN)
- …as the primary point of contact for such requests, documentation, and research . + Perform quality review of documentation to ensure established pharmacy guidelines ... significant changes to patient care/ access to services and have material financial impact for patients and Fairview Pharmacy Services. When necessary, escalate… more
- RELX INC (Philadelphia, PA)
- …our Team Elsevier is singularly focused on helping healthcare professionals improve clinical outcomes through evidence-based care. Our generative AI team works on ... that our AI solutions meet rigorous standards for accuracy, fairness, and clinical relevance. The successful candidate will help evaluate model performance, analyze… more
- CareFirst (Baltimore, MD)
- …Medicare and Medicaid plans as needed. This may also include assistance with financial analyses used in the development of reimbursement policy, strategies, cost of ... competitive analyses to include industry, regional, and internal benchmarks as needed. Research Federal, state and local reimbursement trends and mandates to prepare… more
- CareFirst (Baltimore, MD)
- …and Medicaid plans as needed. This may also include assistance with financial analyses used in the development of reimbursement policy and workflows associated ... with healthcare providers' reimbursement fee levels. Research Federal, state and local reimbursement trends and mandates to prepare reimbursement recommendations for… more
- University of Miami (Miami, FL)
- …. The Reimbursement Pharmacist will perform clinical and financial analysis functions ... health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an… more
- CVS Health (Harrisburg, PA)
- …to determine if additional investigations are warranted. **Key Responsibilities** + Identify, research , analyze and document analytic leads or referrals to send for ... investigative review. + Review company clinical and payment policies to determine the impact of...and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to… more
- Corewell Health (Grand Rapids, MI)
- Job Summary Responsible for the analysis, research and completion of complex member appeal investigations. Effectively administer all steps of the member appeal and ... if pharmacy and medical policies have been applied appropriately or if additional clinical information is available after the original decision + Support root cause… more