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Directs coordination with other environmental engineering activities, including site assessments, ground water remediation, soil remediation, liquid waste testing and disposal, permitting, water conservation, and regulatory compliance.
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Writes and updates infection prevention policies and procedures to insure compliance with regulatory standards of The Joint Commission (TJC) Occupational Safety and Health Administration (OSHA) Centers for Medicaid/Medicare Services (CMS,) Centers for Disease Control and Prevention (CDC) and other nationally organized agencies recommendations and requirements.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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The Manager oversees the resolution of member appeals and grievances for all product lines (Medi-Cal, Medi-Cal Direct, Medicare, PASC-SEIU and L.A. Care Covered) in a manner consistent with regulatory requirements from the Department of Managed Health Care, Department of Health Care Services, Centers for Medicare & Medicaid Services, as well as requirements from the National Committee on Quality Assurance (NCQA) and L.A. Care policies and procedures.
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Knowledgeable of Medi-Cal Managed Care and Medicare compliance, HMO’s and other regulatory agency guidelines. Under the direction of the Operations Director and Executive Director, this position is responsible for the negotiation, optimization and the operational management of the managed care contracts; Medi-Cal, Medicare, Commercial, PPO, FFS and etc.
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Interfaces with Government owned and operated web-based application tool (Health Plan Management System), used for Federal regulatory oversight of Medicare health plans. Maintains internal database of Medicare marketing materials; includes but is not limited to data entry, data validation, and executing monthly QA processes.
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This will require extensive knowledge of CMS Medicare Advantage regulatory requirements, Department of Financial Responsibility (DOFR) provisions, and internal operation requirements, policies, and procedures.
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Process Medicare member claims based on DMHC and DHS regulatory legislature. Process claims based on contractual agreements, health plan division of financial responsibility, applicable regulatory legislature, claims processing guidelines and client groups’ and company policies and procedures.
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Ensures the hospital and maintenance staff maintains compliance with federal, state, city, local regulatory agencies and organizations such as the Office of Statewide Health Planning and Development (OSHPD), Center for Medicare and Medical Services (CMS), The Joint Commission (TJC), Department of Public Health and Human Services (CDPH), Fire Departments, and City Ordinances.
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The ideal candidate must possess extensive care management experience and be a subject matter expert in compliance and regulatory requirements, particularly with a strong understanding of NCQA (National Committee for Quality Assurance) standards.
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The Care Management Department, which oversees all outpatient care management for the Commercial and Medicare lines of business, is seeking a Clinical Program Manager, Principal to join our team.
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Ensure the accurate and timely processing of PDR documents. Experience processing PDR documents. Ability to interpret provider contracts and apply them to claims adjudication. Five or more years of healthcare claim processing experience in a managed care environment.
$24.28 an hourFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Ability to track and trend and create regulatory reporting. A minimum of 5 years’ experience in regulatory auditing (Appeals & Grievances, Call Center, Enrollment) in a healthcare environment is required.
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Quivvy Tech is the fastest growing national telemedicine network in the U.S. We have a triage call center where all patients are pre-screened for medical necessity and to confirm compliance with legal and regulatory standards all while ensuring a positive patient experience.
ExpandApply NowActive JobUpdated 15 days ago - UpvoteDownvoteShare Job
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Prepares journal entries, account reconciliations, monthly management financial reporting package, regulatory reporting and/or executive summary schedules. Actively participate and ensure timely and accurate financial statement reporting for Generally Accepted Accounting Principles (GAAP), Statutory Accounting Principles (SAP), tax and other regulatory reporting.
ExpandApply NowActive JobUpdated 13 days ago - UpvoteDownvoteShare Job
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Managing Medicare Medical Review and Denials process in conjunction with Director of Rehabilitation, the facility, and therapy staff. Assessing, training, and issuing necessary ADL adaptive equipment and durable medical equipment for patients to facilitate independence in ADLs. Writes accurate, complete, and clear documentation in accordance with regulatory, licensing, payor, and accrediting requirements.
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medicare regulatory jobs in Pasadena, CA
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