- CVS Health (OH)
- …to be auditing against the use of clinical criteria, policy procedures, and for compliance purposes. Schedule is Monday - Friday 8:00am - 5:00pm. Will have to ... preferred + Auditing experience + Managed care experience + Medicaid and/or Medicare experience + Systems experience: MedCompass and/or QNXT + Critical thinking… more
- Humana (Washington, DC)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to… more
- US Tech Solutions (May, OK)
- …to obtain additional information. + Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines. + ... **Experience** + 3 years of clinical experience required- Managed Care/ Medicare experience preferred **Position Summary** + Provide comprehensive healthcare… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Responsibilities** **Group ... standard formulas and actuarial information, recognizing system requirements and ensuring compliance with state and federal regulations, and adherence to internal… more
- MetroLink (Los Angeles, CA)
- …of federal, state, regional, and local funding + Responsible for assuring compliance with federal and state regulations and guidelines through timely execution of ... as appropriate + Ensure high-quality work output of departmental and consultant staff + Establish, monitor, and reinforce department policies and procedures,… more
- NHS Management, LLC (Pleasant Grove, AL)
- …Specialist Consultants, Internal Auditor, or any other corporate or regulatory compliance consultant . Communicates progress toward goals and ongoing obstacles ... Specialist Consultants, Internal Auditor, or any other corporate or regulatory compliance consultant . Communicates progress toward goals and ongoing obstacles… more
- Avera (Sioux Falls, SD)
- …(WPS), and CGS Administrators at the present time. + Assists Avera facilities through compliance focused Medicare reviews to resolve and minimize risks for a ... you matter.** **A Brief Overview** Assists HIM/Coding leadership in providing consultant services to health information management departments and billing offices… more
- CenterWell (Phoenix, AZ)
- …the organization in community and marketing events. + Develop and maintain compliance with the departmental and physician budgets. + Assess, develop and recommend ... strategies for compliance with regulatory requirements. + Develop and maintain an...**Preferred Qualifications** + Active and unrestricted DEA license + Medicare Provider Number + Medicaid Provider Number + Minimum… more
- The Joint Commission (Oakbrook Terrace, IL)
- …from the field, analysis of periodic performance reviews, evidence of standards compliance reports, complaints, and Medicare out-of- compliance reports. + ... inductive reasoning skills to determine a health care organization's degree of compliance with applicable standards and functionality of care delivery systems. Field… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- …review program which promotes effective cost recovery, quality of care and/or compliance with relevant federal and state laws, regulations and standards. In the ... care facilities for purposes of maximizing reimbursement revenue via Medicare Part B programs; + May review medical records...review of cases and case referral to a physician consultant for final disposition; + Performs related duties as… more