- RWJBarnabas Health (Oceanport, NJ)
- Quality Officer III ( Medicare )Req #:0000183242 Category:Coder Status:Full-Time Shift:Day Facility:RWJBarnabas Health Corporate Services Department:HIM - Coding ... integrity of ICD-10-CM/PCS coding and DRG assignment for inpatient Medicare encounters. This requires critical thinking and a higher...a team with other Quality Officers to ensure SMART review goals are met for all RWJBarnabas facilities. +… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …fully remote with the ocassional time onsite as needed.** The Sr. Medicare Coverage Analyst (MCA) is responsible for reviewing clinical research protocols, Informed ... insurance and which should be billed to the study sponsor. The Medicare Coverage Analyst determines whether proposed clinical research studies are a Qualifying… more
- Centene Corporation (Jefferson City, MO)
- …accordance with regulatory, state, corporate, and accreditation requirements. + Assist the Medicare CMO in the functioning of the physician committees including ... a fresh perspective on workplace flexibility. + **Position Purpose:** Assist the Medicare Chief Medical Officer to develop and implement our enterprise clinical… more
- UCLA Health (Los Angeles, CA)
- Description As the Program Manager of Medicare Advantage Marketing, you will provide tactical support for implementing innovative marketing strategies and plans for ... New Century Health Plan's Medicare Advantage Growth Office. This position will play a...vendors to create effective marketing solutions. + Oversee the review and approval process for all prospect, member, and… more
- Molina Healthcare (Dayton, OH)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services… more
- Fallon Health (Worcester, MA)
- …integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of ... network, thereby reducing their dependence on the medical system. * Offers proactive review of members for a multidisciplinary care planning with PCPs and Care Teams… more
- Centene Corporation (Jefferson City, MO)
- …cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality assurance, and ... + Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. + Conduct regular… more
- Sutter Health (Sacramento, CA)
- …Sutter Health! **Organization:** SHSO-Sutter Health System Office-Valley **Position Overview:** The Physician Advisor (PA) is a key member of the hospital's ... care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under-utilization of resources, medical necessity,… more
- Catholic Health Initiatives (Omaha, NE)
- …denial management, compliance with governmental and private payer regulations, appropriate physician coding and documentation requirements.** + Review medical ... Message from Medicare (HINN). Discuss the case with the attending physician and if additional clinical information is not available, coordinate the process with… more
- Ochsner Health (New Orleans, LA)
- …Board Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (3) Physician Advisor Sub-Specialty Certification ... make a difference at Ochsner Health and discover your future today!** The Physician Advisor (PA-Utilization Management) serves as the physician leader in matters… more