- CVS Health (FL)
- …highly regulated function, this role will also oversee delegated PBM functions, cross Medicare Pharmacy Organizational Compliance with CMS regulations as well as ... implementation and milestone tracking for business plans as Part of the Medicare benefit and product cycle. Directs the strategic development and implementation of… more
- Molina Healthcare (Orlando, FL)
- …Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state, and local regulatory requirements. **Job ... markets, including D-SNP market performance management. + Function as Medicare subject matter expert and point of contact for...Monitor and support sales and retention efforts. + Monitor compliance and regulatory risks. + Contribute to and present… more
- Humana (Tallahassee, FL)
- …our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. ... The Corporate Medical Director works on problems of diverse scope and complexity...necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD… more
- Humana (Tallahassee, FL)
- …our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The ... Corporate Medical Director works on problems of diverse scope and complexity...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents… more
- Molina Healthcare (Orlando, FL)
- …and resolve. **Knowledge/Skills/Abilities** Responsible for the oversight of regulatory compliance of Corporate Operations functions, including but not limited to ... performance of internal compliance audits, represent Corporate Operations on external regulatory or...a cadence for assessing and adjusting * Monitor internal compliance of Corporate Operations units via establishment of an… more
- Humana (Miami Lakes, FL)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll… more
- Molina Healthcare (St. Petersburg, FL)
- …demonstrate compliance to regulatory requirements. * Supports Manager and Director with developing the Operational Oversight Work Plan, monitoring and reporting ... to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Sr. Analyst develops and… more
- Trinity Health (Pensacola, FL)
- …Improvement Plan for the PACE Organization (PO) and ensure overall CMS regulatory compliance . The Director , Quality Improvement and Compliance , in ... including leading quality initiatives and projects. In addition, the Director ensures that data is collected from appropriate sources,... with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance… more
- AdventHealth (Maitland, FL)
- …local and industry standards, guidelines, rules and regulations to ensure compliance . + Manages department team members by providing application assistance and ... day operations. + Works reports daily, maintaining established goal(s), and notifies Director , of issues preventing achievement of such goal(s). Manages the follow… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing ... home health, SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director ...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All… more