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Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus. Work with internal partners to build strategic patient access and reimbursement account plans and review franchise, market access, and PSS business plans and objectives.
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Equal Opportunity Employer: disability/veteran #Correctional Nurse #Jail Nurse #Naphcare #Everhealth #Full Time #Benefits #Registered Nurse #Detox #Med Cart #Patient Care #County Nurse #State Nurse #Government Nurse #Veteran Nurse #Fixed schedule #12 hour shifts #New grads #New Graduates# Low Cost Benefits #PRN #Part Time #Full Time #Short Term Contract #Travel Nurse.
$38 - $47.5 an hourFull-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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2+ years’ experience providing environmental review support for HUD CDBG-DR programs, such as authoring or reviewing area-wide (Tier 1) environmental review records and authoring or reviewing site-specific (Tier 2) environmental reviews or preparing guidance, policy documents, or process diagrams in support of environmental review.
$95,776 - $162,819 a yearFull-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Medication Therapy Management (MTM), Formulary, Drug Utilization Review (DUR), Opioid Edits, Pharmacy & Therapeutics (P&T), End Stage Renal Disease (ESRD/ Hospice, Fraud, Waste and Abuse (FWA,) and Clinical Decision Making.
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Report to the Senior Manager of Medicare Part D Compliance - Medicare Business Support. Legal Compliance Advisor - Medicare Part D/ Rx Service Operations. The Medicare Part D Legal Compliance Advisor is responsible for compliance support of service operations with specific focus on Medicare clinical programs.
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The Advisor will ensure operational compliance with all regulatory requirements and standards relative to Medicare Part D in assigned areas of oversight. This individual will represent compliance in such a way that ensures (i) all Medicare Part D regulatory requirements are understood, (ii) business processes required to address those requirements are implemented, (iii) compliance risks are communicated to the Legal Compliance Senior Manager and appropriate business leads, and (iv) oversight and approval of compliance related issue corrective actions are executed timely, tracked in accordance with department procedures, and escalated as needed.
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Utilization Review RN. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services mission of Building Healthier Communities Together.
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CBIZ Transaction Advisory Services, part of CBIZ Private Equity Advisory, is the leading national due diligence team for middle market private equity groups and companies. MHM is an independent CPA firm that provides audit, review and attest services, while CBIZ provides business consulting, tax and financial services.
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As a part of the Utilization Management team the Utilization Review RN is a member of the Care Coordination team. The Utilization Review RN Coordinates continuing care/outside services for value based risk members (HMO members) in collaboration with the hospital and primary care physician.
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Certified Case Manager (CCM) or Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR , CPUM, or CPHM) preferred. Performs retrospective (post -discharge/ post-service) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review.
$30.85 - $46.28 an hourPart-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Ability to create documents that, with minimal review, may be presented to U.S Customs & Border Protection. Support ongoing training content and deployment (i.e. Supply Chain Security Policy and Procedure Review and Enhancement.
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Draft, review, and negotiate prime contracts with US Federal Government agencies for the sale of Axon’s goods and services, vendor, and supply. Minimum of 5 years of experience negotiating and administering US Federal Government contracts for sales of goods and services (including SaaS), including but not limited to sales under Federal Acquisition Regulation Part 12 (commercial products and services.
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Perform clinical reviews of Medicare Part A and Part B claims for Medical Review, Redeterminations/Appeals (Appeals), and Prior Authorization requests (collectively, the “Services”) in accordance with CMS (Centers for Medicare & Medicaid Services) requirements.
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This position is a primarily remote, virtual position with occasional in-person meetings between the part-time Corporate Associate Attorney and the Founding Attorney in an office space located in a mutually agreed location.
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Minimum of three to five years of related experience with Medicare Part D required; Compliance experience. Act as a SME in the management of Corrective Action Plans (CAP) and other issue remediation for function specific Part D and FDR related issues.
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