Plans, organizes, staffs, and coordinates all activities of the Health Plans Network Management Department. Works with Staff and Senior Management to develop and implement provider contracting strategies and provider service strategies to improve member access and enhance Provider satisfaction with the Health Plan. Primary Health Plan liaison for Claims, Member Services,

Under direction of both the Director and CDI Manager, the Clinical Documentation Specialist independently prioritizes and performs assigned duties and tasks. Clinical Documentation Specialists are responsible and accountable for the day to day management and success of the Continuous Documentation Improvement Project to include all modalities, acting as a liaison with spe

The Senior Claims Manager will oversee and ensure the efficiency and accuracy of healthcare claims operations. This position oversees the claims inventory by setting, evaluating, and monitoring the claims inventory and examiner production metrics and is responsible for timely and precise benefit determinations for claims, while upholding exceptional service standards for

Bring your ideas. Make history. BNY Mellon offers an exciting array of future forward careers at the intersection of business, finance, and technology. We are one of the world's top asset management and banking firms that manages trillions of dollars in assets, custody and/or administration. Known as the "bank of banks" 97% of the world's top banks work with us as we lead

Location Wichita, KS (Onsite) Key Accountabilities Monitor Spirit for financial compliance with the U.S. Government rules and regulations Responsible for disseminating current policy and providing advice, ensuring effective EVM implementation on new contracts, analysis of contractor performance reports, facilitating Integrated Baseline Review (IBR), risk assessments, supp

The Office for Institutional Equity (OIE) at the Johns Hopkins University (JHU) is seeking a highly qualified, motivated and skilled Equity Compliance Investigator to assist in the handling of equal opportunity issues involving members of the University community, including assessing and investigating complaints of discrimination, harassment, sexual misconduct and retalia

Overview The Market Conduct Examiner (MCE) performs highly complex work involving planning and coordinating market conduct examinations of insurers. Market conduct examinations are done under the direction of the Director of Market Regulation (Director) and require significant interaction with management level staff of insurer organizations. The MCE is responsible for Ass

Under direction of both the Director and CDI Manager, the Clinical Documentation Specialist independently prioritizes and performs assigned duties and tasks. Clinical Documentation Specialists are responsible and accountable for the day to day management and success of the Continuous Documentation Improvement Project to include all modalities, acting as a liaison with spe

Associate, Anti Money Laundering/Prevention/KYC Representative II Bring your ideas. Make history. BNY Mellon offers an exciting array of future forward careers at the intersection of business, finance, and technology. We are one of the world's top asset management and banking firms that manages trillions of dollars in assets, custody and/or administration. Known as the "b

The Highlights The SEVIS Compliance Analyst is responsible for applying federal regulatory parameters to determine whether non immigrant student and exchange faculty members are compliant with Department of Homeland Security (DHS) regulations, as part of the mandatory SEVIS reporting responsibilities of the University. The ISS must meet continuous non negotiable Student a

The Principal IT Regulatory Analyst recommends, develops, and implements IT regulatory strategy and rate case deliverables, and drives supporting processes and tools. This position supports all CPUC and FERC rate cases and proceedings (GRC, TO, RAMP), the IT component of separately filed rate cases (e.g. WGSC), and compliance with all regulatory directives and stakeholder

1) to implement a governance model at a level under the VP of Governance, Risk and Opportunities, and serve as the second line of defense for the Business Unit. And 2) to drive the implementation of risk and opportunities processes and tools during project execution, as well as for the analysis of the risk and opportunities information to maintain visibility of top risks

Educate Providers to ensure they have the tools they need to meet Quality, Risk adjustment, growth (as appropriate) and Total Medical Cost goals per business development plans Ensures Providers have in depth understanding of WellMed Model of Care to include, but not limited to, contractual obligations, program incentives and patient care best practices Conduct detailed an

The essential duties and responsibilities (including but not limited to) Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence. Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.

Under direction of both the Director and CDI Manager, the Clinical Documentation Specialist independently prioritizes and performs assigned duties and tasks. Clinical Documentation Specialists are responsible and accountable for the day to day management and success of the Continuous Documentation Improvement Project to include all modalities, acting as a liaison with spe