- NTT DATA North America (Plano, TX)
- …from CMS collaborating with customers that all appeals are handled in accordance with federal and state laws. + Identify potential compliance risks and implement ... our team. NTT DATA is seeking to hire a ** Medicare Appeals Clinical Leader** to lead service delivery engagements...Prepare reports for senior management on appeal trends and compliance status. **Requirements:** + Requires Bachelor's degree + 8… more
- Gentiva (Fairfax, VA)
- …staffing plans, and cost control strategies + Maintain compliance with federal , state, and local regulations, including Medicare and state survey ... role is responsible for ensuring the appropriate delivery of hospice services, compliance with Medicare Hospice Benefit Conditions of Participation, state… more
- BAYADA Home Health Care (Fayetteville, NC)
- …supervision and support to field RNs, LPNs, and clinical staff + Ensure compliance with Medicare Conditions of Participation (CoPs), state regulations, and ... Care is seeking a **Clinical Manager (RN required)** for our **Fayetteville, NC** Medicare Certified, **Home Health** office. Do you want to be part of providing… more
- Humana (Lansing, MI)
- …Clinical Leadership teams to ensure utilization reviews comply with Centers for Medicare & Medicaid Services (CMS) regulations as well as Michigan Dual Special ... and Human Services (MDHHS) standards. + Works in conjunction with Humana's Medicare UM Committees to ensure adoption and consistent application of appropriate… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... for Fallon Health government and state sponsored products including Medicare Advantage, Commercial/ACA, PACE, and Medicaid. **Responsibilities** **Primary Job… more
- New York State Civil Service (New Hampton, NY)
- …you cannot be listed as an excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other ... policies and procedures and ensure staff competencies are current and in compliance with nursing standards Minimum Qualifications Candidates from outside or within… more
- New York State Civil Service (Ogdensburg, NY)
- …you cannot be listed as an excluded individual or entity on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other ... policies and procedures and ensure staff competencies are current and in compliance with nursing standards Minimum Qualifications Candidates from outside or within… more
- Elara Caring (Ludington, MI)
- …staffing levels at branch locations to meet patient needs. + Ensures compliance of current Medicare , Medicaid, and third-party reimbursement regulations and ... all documentation is accurate, complete, timely and adheres to Medicare guidelines. + Assures compliance with the...implementation of plan of corrections in conjunction with state, federal , internal, or other auditing or regulatory bodies. +… more
- CenterWell (Kansas City, KS)
- …in on-call rotation and support growth initiatives at your center. + Ensure compliance with all licensing and accreditation requirements. **Use your skills to make ... **Preferred:** + Experience in value-based care, primary care or Medicare Advantage settings. + Active DEA license and ...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Kelly Services (Avon, CT)
- …service team in Avon, CT. This role is focused on providing support to Medicare participants, primarily individuals aged 65 and older. The ideal candidate will have ... **Key Responsibilities:** + Serve as the primary point of contact for Medicare members, providers, pharmacies, and other insurance carriers. + Assist with claim… more