- Highmark Health (Dover, DE)
- …reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. The incumbent responds to physician and ... in accordance with timelines as defined by state and federal regulations to insure appropriate notification issuance to prescribing...across multiple states. They must also be familiar with Medicare drug benefit design offerings that may differ by… more
- The County of Los Angeles (Los Angeles, CA)
- …action where necessary. Formulates policies and procedures concerning program administration, ensuring compliance with Federal and State Medicare and ... programs in meetings with representatives of other County departments, State and Federal agencies, and other public and private entities. In conjunction with the… more
- SGI Global, LLC (Grand Rapids, MI)
- …various environmental laws. There is a special emphasis on fraud matters involving federal health care programs including Medicare and Medicaid. The contractor ... program. Typical investigations involve: (1) monetary fraud against a multitude of federal programs or (2) civil violations of statutes such as the Controlled… more
- Spokane County (Spokane, WA)
- …the regional behavioral health crisis line, and contacting 911. + Follows federal and state laws on compliance , confidentiality, and security protocol. ... System for Award Management (SAM) excluded provider, in any capacity for the Medicare , Medicaid, and all Federal healthcare programs. + Maintain professional… more
- MyFlorida (Alachua, FL)
- …and federally certified health care facilities meet the established state and/or federal requirements and patients and residents receive safe, quality health care. ... and holidays. This position requires successful completion of all Center for Medicare Services (CMS) Quality, Safety & Education Portal (QSEP) training for Life… more
- UTMB Health (Galveston, TX)
- …reports to identify standard-of-care, research-related, or indeterminate services. + Follows federal and state regulations to ensure compliance standards are ... to ensure Principal Investigators and other billing entities comply with federal and state regulations for clinical research billing. **Scope:** **_NA_** **ESSENTIAL… more
- Highmark Health (Pittsburgh, PA)
- …(COB), and processing of claims with unique processing arrangements including Federal Employee Program (FEP) and Medicare Advantage. **ESSENTIAL ... rules, regulations, and laws of the hospital and all federal and state regulatory bodies. **QUALIFICATIONS** **Minimum** + Bachelor's...includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well… more
- Covenant Health Inc. (Lenoir City, TN)
- …information in response to subpoenas, court orders, attorney requests, state and federal agency investigations, and other inquiries from outside sources. + Maintains ... and regulations concerning patient care, including those mandated by state and federal agencies and incident reporting. Also includes investigative activities with … more
- Elevance Health (Seattle, WA)
- …restrictions. Process prior authorization requests from healthcare providers to ensure compliance with Medicare requirements, and inform relevant parties of ... of gender, race, or any other category protected by federal , state, and local pay equity laws _._ *...acceptable explanation. Elevance Health will also follow all relevant federal , state and local laws. Elevance Health is an… more
- Molina Healthcare (Davenport, IA)
- …Centers for Medicare and Medicaid Services (CMS), and state and federal guidelines and requirements. * Reports outcomes, identifies areas of re-training for ... functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide… more