- Molina Healthcare (Roswell, NM)
- …Specialist, Quality Program Management and Performance implements new and existing healthcare quality improvement activities to maintain compliance with quality ... collaboratively with other departments to ensure quality programs meet regulatory requirements. **Job Duties** + Conducts quality program management activities… more
- HCA Healthcare (Lake City, FL)
- …and policies and procedures. Ensure compliance with quality patient care and regulatory compliance . + Ensures compliance with all regulatory ... on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny… more
- Molina Healthcare (Provo, UT)
- …+ Review Medicaid COB claims for correct secondary pricing logic and compliance with configuration and regulatory rules. + Analyze claim outcomes ... our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing. This role… more
- Molina Healthcare (Las Cruces, NM)
- …groups. * 3+ years experience in provider contract negotiations in a managed healthcare setting **PREFERRED EXPERIENCE** : Knowledge of integrated delivery ... Health, Home Health, Hospice, Dialysis, Home and Community based providers. Ensure compliance with Corporate standards and regulatory requirements and review… more
- Prime Healthcare (Reno, NV)
- …between hospital administration and the medical staff, ensuring effective communication, regulatory compliance , and alignment with institutional goals. The ... are some of the benefits of working at Prime Healthcare : + Health, dental, and vision insurance options +...staff functions are performed accurately and timely. + Oversees compliance with regulatory and accreditation standards, including… more
- AmeriHealth Caritas (Columbus, OH)
- …+ Preferred experience level: at least 3 years of experience in healthcare compliance .; **Our Comprehensive Benefits Package** Flexible work solutions include ... **; Compliance Oversight** + Accountable for documentation of all regulatory issued memos, notices, bulletins, contractual requirements, reports, and … more
- HCA Healthcare (Nashville, TN)
- …One of the nation's leading provider of healthcare services, HCA Healthcare is made up of locally managed facilities that include approximately ... in the process. + Stays abreast of general industry, regulatory and economic developments and applies their understanding to... compliance + Clinical documentation improvement (CDI) process compliance + Special Projects HCA Healthcare has… more
- Molina Healthcare (Dayton, OH)
- …Works with Legal and Corporate as needed to modify templates to ensure compliance with all contractual and/or regulatory requirements. + Oversees plan-specific ... or related field. **Required Experience** + 10+ years progressive experience in Healthcare Administration, Managed Care and/or Provider Services. + Experience… more
- Molina Healthcare (Vancouver, WA)
- …other Molina departments as needed + Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings ... education and work experience. + 3 years' experience in healthcare with a minimum of 2 years' experience in...of 2 years' experience in health plan member interventions, managed care, or equivalent experience. + Demonstrated solid business… more
- Molina Healthcare (Houston, TX)
- …appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) ... knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and… more