- AmeriHealth Caritas (Washington, DC)
- …utilization review processes, including medical necessity criteria, care coordination, and regulatory compliance . + Demonstrated ability to meet productivity ... patient care + Analyze medical records and clinical data to ensure compliance with regulatory and payer guidelines + Communicate determinations effectively,… more
- Robert Half (Dallas, TX)
- …and other relevant accounting standards. + Identify ing audit findings, regulatory compliance risks, and operational inefficiencies, and provide recommendations ... to be more effective and efficient in a way that is risk-sensitive, regulatory compliant, well controlled, and enabled by leading technologies. What You Can Expect:… more
- Ventura County (Ventura, CA)
- …in direct patient-care positions. The Health Care Agency is a comprehensive healthcare system that encompasses the Ventura County Medical Center (VCMC), Santa Paula ... Health and Safety code for VCHCP, a Department of Managed Health Care (DMHC) licensed Commercial HMO. This position...Plan, VCHCP is required to be compliant with all regulatory requirements of any other large insurance plan. The… more
- Trinity Health (Columbus, OH)
- …**MOUNT CARMEL HEALTH SYSTEM** Mount Carmel Health System (MCHS) looks at healthcare differently. Beyond providing exceptional and advanced care when people need us ... performance in alternative payment models. Collaborates with MCHS and Trintiy Health managed care teams on APM contracting. Attends Board meetings and reports… more
- Humana (Springfield, IL)
- …provider townhalls and/or trainings. + Attend Network Meetings/Conferences. + Ensure compliance with all Virginia managed care contractual requirements for ... and grows positive, long-term relationships with physicians, providers and healthcare systems. The Provider Engagement Professional (Physician and LTSS) roles… more
- Houston Methodist (Nassau Bay, TX)
- …continued stay and resource use, appropriate level of care and program compliance . Identifies when services no longer meet InterQual/Millman l criteria, initiates ... Performs post-discharge review by analyzing the inpatient record to ensure that compliance with quality indicators are met. Intervenes and takes appropriate action… more
- Baylor Scott & White Health (Temple, TX)
- …It also involves vendor selection, productivity, performance standards, patient safety, regulatory compliance , and continuing education. Establishes and monitors ... communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live...Identifies and implements best practice programs and processes. Ensures compliance with all regulatory areas and legal… more
- Fresenius Medical Center (Vancouver, WA)
- …and activities of dialysis facilities and programs in an assigned area ensuring compliance with established company and regulatory guidelines and procedures in ... containment strategies, maintaining profitability and growth of area while ensuring compliance with all pertinent company policies and regulatory requirements.… more
- Boehringer Ingelheim (Los Angeles, CA)
- …to physicians verbally in a clear, effective and accurate manner in strict compliance with regulatory and other requirements. Attendance / Schedule At least ... to physicians verbally in a clear, effective and accurate manner in strict compliance with regulatory and other requirements. Attendance / Schedule At least… more
- Mount Sinai Health System (New York, NY)
- …and implement policies and procedures that promote efficiency, data integrity, and regulatory compliance (eg NYS, CMS). + Monitor key performance indicators ... EHR systems. + Organizes routine meetings with health system business leaders and managed care to review payer issues and denials. + Builds effective, collaborative… more