- Helio Health Inc. (Binghamton, NY)
- …trainings, including but not limited to Sexual Harassment, Cultural Competency, and Helio Health Compliance Plan training. + Supports periodic new colleague ... Overview Helio Health is on a mission to treat and...promote recovery from the effects of substance use, mental health disorders, and other behavioral healthcare issues. To support… more
- Molina Healthcare (GA)
- …line of business. * Oversees Enrollment and Contact Center Operations to ensure compliance with health plan requirements. Works collaboratively with ... **Job Description** **Job Summary** Molina Health Plan Operations jobs are responsible...with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant… more
- ManpowerGroup (Houston, TX)
- …in accordance with the Compliance Program, and with HHSC, TDI, NCQA and Health Plan Senior Management. * Ensure ongoing compliance with federal and ... internal and external auditing and real-time monitoring activities related to the Health Plan 's regulatory and contractual requirements in accordance with the… more
- Centene Corporation (Austin, TX)
- …fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy ... one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national… more
- Geisinger (Harrisburg, PA)
- …the broker network. + Deliver training sessions on Geisinger Health Plan products, underwriting guidelines, and compliance requirements. + Ensure brokers ... ensuring they are equipped to successfully promote and sell Geisinger Health Plan products. This role focuses on broker engagement, training, sales support,… more
- UCLA Health (Los Angeles, CA)
- …medical appropriateness by using established clinical protocols and health plan resource tools + Assess compliance with healthcare regulations, accreditation ... responsible for conducting comprehensive facility site reviews (FSRs) to ensure compliance with healthcare standards and regulations. This role involves evaluation… more
- Cedars-Sinai (CA)
- …maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, ... plans and current CSHS departments to ensure both health plan regulations and CSHS policies are...plan audits and regulatory audits. + Provides required Compliance and FWA trainings for existing, new employees and… more
- Cedars-Sinai (Los Angeles, CA)
- …+ Provides clinical expertise and support with quality assurance, performance improvement, and health plan compliance for clinical trial compliance . ... such as research quality management or clinical trial recruitment efforts. Ensures compliance with all federal and local agencies including the Food and Drug… more
- Pacific Medical Centers (Renton, WA)
- …criteria and processes. Responsible for the non-clinical utilization management functions of the Health Plan . Responsible for compliance with the DoD ... meets URAC and DoD standards, and that there is compliance with all elements of the TRICARE Management Activity...Acts as a representative and spokesperson for US Family Health Plan both internally and externally. Responsible… more
- LA Care Health Plan (Los Angeles, CA)
- …financial solvency compliance with regulatory and contractual requirements for plan partners, PPGs, capitated hospitals, specialty health plans, and vendors. ... (Mid.) - $188,015.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency...and implementation of reports and tools for corrective action plan issuance and non- compliance notifications. Manages the… more