- CVS Health (TX)
- …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 (Austin, TX)
- …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 (Austin, TX)
- …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 (Austin, TX)
- …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 (Houston, TX)
- …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
- Houston Methodist (Katy, TX)
- …Access Services, and Utilization Review as needed to ensure operational billing compliance with government/regulatory agencies and the Medicare and Medicaid ... position provides guidance to staff and is responsible for staffing, budget compliance , contributing to staffing decisions such as hiring and terminating employment,… more
- Molina Healthcare (Austin, TX)
- …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
- Humana (Austin, TX)
- …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
- UTMB Health (Galveston, TX)
- …appropriate processes and procedures to ensure compliance with Medicare and Medicaid regulations. + Supports Director , Finance-Government Reimbursement ... government payor reimbursement-related calculations and estimates and ensures UTMB compliance with Medicare and Medicaid regulations. **Scope:** Institutional… more
- Humana (Austin, TX)
- …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more