- CareFirst (Baltimore, MD)
- …data to evaluate implications across various business lines, while ensuring compliance with company policies and procedures, and coordinating with the Payment ... amendments, and participate in internal workgroups and committees, ensuring compliance and advising on business strategies. **ESSENTIAL FUNCTIONS:** **Contract… more
- ChenMed (Berwyn, IL)
- …mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to be ... acts as a health coach, rather than just a consultant for sickness, by helping patients set short and...with the applicable managers and medical directors to ensure compliance with guidelines along with participating in risk and… more
- ChenMed (Richmond, VA)
- …mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to be ... acts as a health coach, rather than just a consultant for sickness, by helping patients set short and...with the applicable center and market leadership to ensure compliance with guidelines along with participating in risk and… more
- Takeda Pharmaceuticals (Boston, MA)
- …access analytics, including but not limited to; Pricing, Pricing Compliance , Government Price Reporting, Planning, Contract Administration, Rebates, Group Purchasing ... align cross-functional teams amongaccess, government pricing, legal, marketing and compliance operations + Leading Pricing Governance Committee, Contract Assessments,… more
- NJ Sharing Network (New Providence, NJ)
- …Summary: The Hospital Development Specialist (HDS) performs as a donation consultant to hospitals. Responsible to develop, market, monitor and implement policies, ... outcomes. Evening and weekend work is required. Responsible for timely compliance with all Network programs and policies. Duties and Responsibilities Essential… more
- Sutter Health (Santa Rosa, CA)
- …best practices, level of care progression, denial management and compliance with governmental regulations and conditions of participation and commercial ... in the appropriate level of care with supporting documentation of regulatory compliance and accurate coding. The Physician Advisor (PA) conducts clinical reviews on… more
- Trinity Health (Columbus, OH)
- …, a college of nursing (https://www.mccn.edu/) , a Medicare Advantage plan (https://www.medigold.com/) , and extensive outreach and ... Improvement Activities + o Maintains knowledge of clinical indicators and compliance requirements + o Provides concurrent medical record review for assigned… more
- SSM Health (St. Louis, MO)
- …+ Facilitates compliance with The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS) and state quality and patient safety requirements by ... Event meetings, teams, work groups, and huddles. Serves as a patient safety consultant to various other committees to ensure integration of patient safety work… more
- Sutter Health (Emeryville, CA)
- …best practices, level of care progression, denial management and compliance with governmental regulations and conditions of participation and commercial ... in the appropriate level of care with supporting documentation of regulatory compliance and accurate coding. The Physician Advisor (PA) conducts clinical reviews on… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …on matters regarding progression of patient care, medical necessity, compliance with regulatory guidelines, payer relationships; clinical documentation integrity, ... with Hospital objectives related to quality care of patients, regulatory compliance , and utilization management (including LOS). 4. The Physician Advisor should… more