- Evolent (Helena, MT)
- …in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization ... for utilization management while working in conjunction with the Senior Medical Director. **Qualifications** + MD/DO/MBBS Degree + Current,...by any state or federal health care program, including Medicare or Medicaid , and is not identified… more
- UPMC (Pittsburgh, PA)
- …estate, labor and employment, antitrust, insurance, commercial and finance; Medicare , Medicaid , licensure, accreditation, malpractice liability, medical staff, ... **Responsibilities:** + Independently, but subject to general supervision and oversight of Senior Associate Counsel and VP and other senior UPMC attorneys,… more
- University of Miami (Miami, FL)
- …the mandates by state and federal programs, inclusive of the Centers for Medicare and Medicaid Services. Maintains fluency of provider workflows across UHealth ... measures. Participates in strategic planning and conduct problem analysis for senior management. CORE JOB FUNCTIONS + Performs measurement and benchmarking of… more
- UPMC (Pittsburgh, PA)
- …among others: federal and state health care laws and regulations (eg Medicare , Medicaid , licensure, accreditation, malpractice liability, medical staff, patient ... areas of regulatory and patient care law. Conduct legal research and perform legal analysis. + Under general supervision...analysis. + Under general supervision and guidance of more senior UPMC attorneys, responsible for one or more of… more
- Dana-Farber Cancer Institute (Boston, MA)
- …Commission on Accreditation of Healthcare Organizations and the Center for Medicare and Medicaid Services' Conditions of Participation regulations regarding ... is a leader in life changing breakthroughs in cancer research and patient care. We are united in our...Works closely with the P/FR Director, and other P/FR senior staff, along with clinical and operational leaders to… more
- Houston Methodist (Houston, TX)
- …managed care payers include commercial payers, separate transplant contracts, Medicare Advantage, Medicaid Health Maintenance Organizations (HMOs), ... procedures, new drugs. Analyzes proposals which include capitation reimbursement, Medicare resource-based revenue value scale (RBRVS) values, current procedural… more
- Evolent (St. Paul, MN)
- …is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... exclusion or sanction by any state or federal health care program, including Medicare or Medicaid , and is not identified as an "excluded person" by the Office of… more
- Evolent (Helena, MT)
- …is recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... exclusion or sanction by any state or federal health care program, including Medicare or Medicaid , and is not identified as an "excluded person" by the Office of… more
- The Joint Commission (Washington, DC)
- …the regulatory agendas of federal departments and agencies such as the Centers for Medicare and Medicaid Services (CMS); the Department of Health and Human ... sources and federal organizations such as the Government Accountability Office; the Medicare Payment Advisory Commission; the National Academy of Medicine; and other… more
- Guthrie (Sayre, PA)
- …and insurance regulations as well as The Guthrie Clinic policies, as applicable, Medicare , Medicaid , and LCD (Local Coverage Determinations), and NCD (National ... Summary: A senior level compliance coding auditor conducting assessments in...of outcomes and any need for corrective actions. + Research risk areas and compliance concerns related to coding… more