- Commonwealth Care Alliance (Springfield, MA)
- …as NP or PA in primary care or care management AND 3+ years' experience as Registered Nurse or EMT-P in a high touch clinical environment or home care; OR ... and referrals to LTSS providers + Medication Reconciliation + Proactive and routine well-visits and preventative care + Evaluate...or PA graduate, must have 5+ years' experience as Registered Nurse or EMT-P in a high… more
- Highmark Health (Dover, DE)
- …**Required** + Licensed Social Worker (LSW)-Non-Specific - State **(OR)** Registered Nurse - Non-Specific **(OR)** Licensed Professional Counselor ... of available resources for addressing identified member needs and to facilitate proactive and efficient provision of services. + Be knowledgeable of and consider… more
- Humana (Corpus Christi, TX)
- …process management as needed. Requires applicable State licensure in field of study: Registered Nurse ( RN ), Licensed Masters Clinical Social Worker (LCSW), ... 1 consults and collaborates with clinicians to ensure high accountability of compliance and quality. The Quality Assurance, Clinical Professional 1 work assignments… more
- University of Utah Health (Salt Lake City, UT)
- …Review or Case Management experience. **Licenses Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one within 90 ... + This position is responsible to work with the acutely admitted Traditional Medicare , Medicare Advantage, Commercial, Federal, State and unfunded patients. + It… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …in confidentiality, integrity, creativity, and initiative */License/Certifications:/* * Current Registered Nurse licensure upon hire * National certification ... the care team * Collaborates with nursing, physicians, admissions, fiscal, legal, compliance , coding, and billing staff to answer clinical questions related to… more
- CenterWell (Savannah, GA)
- …to the strategic intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: ... to individual clinicians about patient terminations, in + collaboration with Compliance + Supporting clinicians with schedule templates, coverage, daily issues +… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …investigating and remediating allegations of FWA while adhering to compliance and regulatory requirements. Primary activities include substantiating referrals, case ... accuracy of information provided to providers, regulators, law enforcement, Legal, Compliance and outside counsel. Prepares cases for prosecution, civil settlement,… more
- Commonwealth Care Alliance (Boston, MA)
- …enhance the risk adjustment data ecosystem. + Support audit readiness and regulatory compliance for Medicare and Medicaid risk adjustment programs. + Represent ... in SQL, data integration, and systems development are essential. Knowledge of Medicare risk adjustment methodologies is highly desirable. The ideal candidate is a… more
- Commonwealth Care Alliance (Boston, MA)
- …direct supervision for the Clinical Support Coordinators (CSCs) to ensure proactive administrative clinical team support and accurate, prompt, and courteous service ... staff provide quality patient care and service delivery through proactive work and by responding to inquiries immediately and...to meet team needs. * Adhere to all applicable compliance requirements and the Code of Conduct. * Provides… more
- Baystate Health (Springfield, MA)
- …for leading the hospital's enterprise-wide strategies in **patient safety** and **regulatory compliance ** . Reporting to the **Chief Medical Officer (CMO)** , this ... The VP oversees incident management, risk mitigation, policy development, and proactive strategies to reduce harm while supporting the hospital's mission of… more