- Lilly (Indianapolis, IN)
- …reimbursement, and access (PRA), grant submissions and contracts; contacts with regulatory and other governmental agencies; the outreach medical activities ... "patient journey" and the strategic plan for the compound), medical support for regulatory affairs and interactions...of other meetings with health care professionals. + Support medical information associates in preparation and review … more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity screening to ensure ... accurate perioperative pre-authorization and patient class order reconciliation process. Assesses compliance to regulatory and health plan requirements for… more
- Tenet Healthcare (Detroit, MI)
- …in the case management system Follows the payor dispute processes utilizing secondary medical review , peer to peer and payor type changes (25% daily, ... is sequenced and at the appropriate level of care Compliance with state and federal regulatory requirements,...Medical Necessity and submits case for Secondary Physician review per Tenet policy Ensures timely communication and documentation… more
- US Tech Solutions (IL)
- …State + Ensure all **promotional materials** are reviewed by cross functional teams, medical , regulatory , compliance and others as required by Client ... Materials Review Process, as needed; communicate with teams to ensure local review compliance + Manage Affiliate processes as required for local events… more
- Bassett Healthcare (Oneonta, NY)
- …in accordance with standard operating procedure to support reimbursement and regulatory compliance and patient care. When appropriate prior authorizations ... best quality of life possible. What you'll do The Medical Office Assistant II serves as the first point...capture and data entry (such as MSPQ) necessary for regulatory agencies and compliance requirements is accurate… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …CPR's Director and Clinical Lead, Operations Lead, Senior Credentialing Manager/ Compliance Consultant, Risk Specialist, Exception Review Specialists and Project ... Review Units + Prepare documentation in response to regulatory inquiries (eg, subpoena, regulatory filings, CMS...+ Proven competency with quality assurance reviews and strong medical record review background. + Strict adherence… more
- Centene Corporation (Jefferson City, MO)
- …to ensure services were administered with quality, cost efficiency, and are within compliance . + Performs a clinical review and assessment of relevant complex ... of care issues and, if identified, refer to the Medical Director for review and verification +...member's clinical information in health management systems to ensure compliance with regulatory guidelines + Collaborates and… more
- CVS Health (Tallahassee, FL)
- …care of patients with severe, complex, and/or treatment resistant illnesses through peer review and educational interventions. * Work with medical director teams ... / physical professional associates, the local provider community, state regulatory agencies and advocacy groups to advance clinical excellence...focusing on inpatient care management, clinical coverage review , member appeals clinical review , … more
- Astellas Pharma (Northbrook, IL)
- …including diagnostic partners, testing labs, key external experts, advocacy groups, medical organizations and regulatory bodies, to strengthen the company's ... Plans. Present to executive leadership at Global Launch Readiness Review meetings, optimizing readiness for an exceptional launch +...ACCME and OIG. Is able to apply legal and compliance knowledge to Medical Affairs activities +… more
- HCA Healthcare (Nashville, TN)
- …and action taken on the account in accordance with policies and procedures. Escalate medical review request and /or denial activities to management as needed. ... companies to resolve denials/appeals if needed. + Demonstrates knowledge of regulatory requirements, Ethics and Compliance policies, and quality initiatives;… more