- CareOregon (Portland, OR)
- …medical interventions as delegated by registered nurse/clinician. + Perform duties in compliance with Medicare Condition of Participation. + Responsible for ... care costs and increase provider/care team satisfaction. Housecall Providers has saved Medicare millions of dollars, while providing better care to our patients,… more
- UCLA Health (Los Angeles, CA)
- …identifying strengths, weaknesses, opportunities, and risks. + Monitor and ensure compliance with Medicare /Medi-Cal cost reporting rules and regulations, while ... operational effectiveness of UC Hospitals. Elevate your expertise in Medicare and Medi-Cal reimbursement while making a meaningful impact...reimbursement while making a meaningful impact on policy and compliance . You can do all this and more at… more
- Highmark Health (Lincoln, NE)
- …charges; will monitor internal referrals from sources such as claims, customer service, Medicare C&D Compliance , and Fraud Hotlines; will alert Investigators of ... the need for further analysis; will perform claims system extracts and create reports, graphs and charts to support case documentation; will prepare necessary correspondence to set and monitor provider and member claim system flags; will work with external… more
- Humana (Lansing, MI)
- …for our Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of ... the practice of Pharmacy and implements changes as necessary to maintain compliance supporting both the business and public relations strategies. + Develops… more
- Humana (Honolulu, HI)
- …appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana ... experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Topeka, KS)
- …medical necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD represents ... experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Molina Healthcare (Caldwell, ID)
- …to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Sr. Analyst develops and ... analyzes state and federal regulatory rules, contracts, and other guidance to assess compliance and support building regulatory compliance audit procedures. * At… more
- CVS Health (Columbus, OH)
- …with heart, each and every day. **Position Summary** Contributes to the Medicare Dental product portfolio, conducting market analysis and driving new product ... cross-functional collaboration. Drives innovation, evaluates performance, and ensures regulatory compliance , playing a pivotal role in guiding the organization's… more
- CVS Health (Phoenix, AZ)
- …technical, analytical, and business support for all assigned programs for Medicare , Medicaid, and Commercial products. Programs currently include End-Stage Renal ... will also be required to speak to Med D compliance and reporting documentation associated with our clinical programs....**Knowledge of:** + 3+ years of Pharmacy Benefit Management, Medicare Part D or Medicaid experience + 2 +… more
- BlueCross BlueShield of North Carolina (NC)
- …for completion of complex actuarial or analytical projects, ensuring timeliness, compliance , and quality of work + Provide proactive and strategic thought ... 9 years of relevant actuarial experience. **Bonus Points** + Experience in Medicare Advantage Risk Adjustment highly preferred **What You'll Get** + The opportunity… more