- Banner Health (Phoenix, AZ)
- …preparing and delivering reports and presentations, analyzing, developing, and/or submitting Medicare Advantage and Prescription Drug plan bid pricing tools and/or ... direct the preparation of rate filings to Centers for Medicare and Medicaid Services (CMS), Health and Human Services...are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved. 4.… more
- Commonwealth Care Alliance (Boston, MA)
- …oversight, and efficiency of UM processes and functions. * Ensures compliance with all contract requirements, state and federal regulatory requirements and ... degree in Business or Health related field preferred Required Licensing: * active RN license required Required Experience: * 7-10 years * 8-10 years of managed… more
- Humana (Indianapolis, IN)
- …**Preferred Qualifications** + Licensed healthcare professional in the state of Michigan: LPN, RN , LSW, LISW. + Previous Medicare /Medicaid, MDHHS, CMS, and NCQA ... Assurance Professional reviews LTSS contractor documentation and performance to ensure compliance with contract scope of work, and state and federal regulations.… more
- Humana (Richmond, VA)
- …timely and culturally competent delivery of care, services, and supports in compliance with the Virginia Department of Medical Assistance Services (DMAS) contractual ... Leads development of care management policies and procedures to ensure compliance with Commonwealth and federal requirements and incorporate industry best practices.… more
- Marshfield Clinic (Beaver Dam, WI)
- …experience and licensing of each. 10. Maintains personal competency in clinical RN and supervisory role. 11. Knows and forwards information consistent with current ... federal regulations in state and federal codes and Joint Commission and coordinates compliance . 12. Assumes overall accountability for the delivery of care in the… more
- Seattle Children's (Seattle, WA)
- …+ As per the College of American Pathologists (CAP) and the Centers for Medicare and Medicaid Services (CMS), for RN 's performing moderately complex point of ... development to meet current and anticipated needs and to maintain compliance with patient safety and regulatory requirements. **Relocation assistance offered to… more
- Martin's Point Health Care (Portland, ME)
- …metrics, production, and phone queues. The Supervisor also ensures compliance with regulatory requirements, benefit interpretation, professional standards of ... groups, and other strategic and operational interdepartmental initiatives. + Ensures compliance with and integrity of all departmental processes and policies,… more
- Molina Healthcare (Cambridge, MA)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid) Executes health plan's member and community quality ... or Healthcare Administration + 1 year of experience in Medicare and in Medicaid managed care + Certified Professional...Certified Professional in Health Quality (CPHQ) + Nursing License ( RN may be preferred for specific roles) + Certified… more
- Kelsey-Seybold Clinic (Webster, TX)
- …and to improve the efficiency and effectiveness of resources + Ensure compliance with legal, regulatory, and clinical policies and procedures **Essential Duties and ... documentation of patient care by team NP (s) or RN + Education of staff + Adhere to the...is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated… more
- Commonwealth Care Alliance (Boston, MA)
- …with state elected officials, staff, and agencies. + Support the corporate compliance department to interpret and implement applicable provisions of legislation and ... of three (3) years of experience with Medicaid & Medicare managed care and other public health care programs...(nice to have):** + 2-4 years' experience as a registered lobbyist/advocate. + Public Speaking + Charitable giving experience… more