- CareFirst (Baltimore, MD)
- …utilization of referral services. Enhances quality of care by assuring compliance with policies, including safety, infection control, regulatory and accreditation ... and implementation of procedures. + Analyzes eligibility of programs ensuring compliance with board approved regulations. Monitors changes in regulations and… more
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- …position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare , (CM), Medicare ... Insurance Specialist, GS-0107-12, you will develop, evaluate and implement compliance , audit and oversight requirements, policies, operating procedures related to… more
- Sutter Health (San Jose, CA)
- …laws, standards and regulations. Establishes protocols and practices, ensuring compliance with department, affiliate, operating unit, and/or system standards, ... as they relate to Outpatient Services is required, including but not limited to Medicare , MediCal, Medicaid, Knox Keene Act and the Starke II Statute. + An… more
- Molina Healthcare (Cleveland, OH)
- …milestones to stakeholders and leadership. + Ensures quality standards and compliance with company policies. + Facilitates meetings, workshops, and presentations. + ... Health Plan requirements and timelines are met + Understands Medicaid and Medicare business scenarios and appreciates the member environments we serve + Exposure… more
- Bristol Myers Squibb (Princeton, NJ)
- …role is responsible for contracting strategy and analytics for commercial and Medicare payers and also supports field-facing team members in contract negotiations. ... + Utilizes sophisticated analytical techniques to analyze and monitor customer compliance and performance against contract terms and keeps the RAE/NAE informed… more
- BrightSpring Health Services (Mount Laurel, NJ)
- …meetings + Demonstrating fiscal accountability by monitoring operations to ensure compliance with Company policies and procedures, state licensure and regulations, ... Medicaid and Medicare standards, as well as state reimbursement regulations + Leading case conferences and other client-related meetings + Chairing committees as… more
- Genesis Healthcare (CO)
- …to meet those goals. *Provide guidance, oversight, and direction for compliance of auditing activities and investigations related to MDS and reimbursement. ... Nurse or equivalent professional license (ie Physical Therapist) *Must have Medicare and State-specific Medicaid experience (as applicable). *Must be willing to… more
- Atlantic Health System (Morristown, NJ)
- …safety grade - its highest - twelve consecutive times, and the Centers for Medicare and Medicaid Services awarded us again with its highest five-start rating in ... Accounts + Pet, Home & Auto, Identity Theft and Legal Insurance Note: In Compliance with the NJ Pay Transparency Act (effective Sunday, June 1, 2025), all job… more
- PruittHealth (Norcross, GA)
- …forms/documents as necessary for completion of payor enrollment in Commercial Plans, Medicare and Medicaid in accordance with payor standards. . Perform necessary ... including the right to wage complaints. 13. Complies with corporate compliance program. 14. Reports job-related functions/tasks that involve occupational hazards.… more
- CVS Health (OH)
- …to maintain and enhance provider networks while meeting and exceeding accessibility, compliance , quality, and financial goals and cost incentives + Manages contract ... Commercial HMO, PPO products knowledge + 3-5 years related experience Medicare and/or Medicaid products knowledge + Knowledge of Kentucky/Ohio network **Preferred… more