- Molina Healthcare (Dallas, TX)
- …to meet critical needs + Escalates gaps and barriers in implementation and compliance to AVP, VP and senior management + Consultative role, develops business case ... methodologies for programs, develops and coordinates implementation of business strategy + Collaborates and facilitates activities with other units at corporate and Molina Plans. **JOB QUALIFICATIONS** **Required Education** Bachelor's degree or equivalent… more
- Humana (Houston, TX)
- …everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Sales Field Agents. This is a **field** **-based** role, and candidates must ... community. As part of a collaborative team of 8-12 Medicare Sales Field Agents, you'll work under the guidance...under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll… 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
- 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
- Baylor Scott & White Health (Round Rock, TX)
- **JOB SUMMARY** The Regional Clinical Compliance Director is responsible for planning, developing, and enforcing clinical compliance programs for Baylor ... and White Health (BSWH), which may include varied nursing compliance functions and programs including regulatory compliance ...such as the Joint Commission and the Centers for Medicare and Medicaid (CMS). Responds and reacts to changes… 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)
- …health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments ... data requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical... rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and support staff to… 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
- Health Care Service Corporation (Richardson, TX)
- …company that will invest in your professional development. **Job Summary** The Executive Director , Medicare Part D Actuarial will lead the actuarial function for ... insights into actionable recommendations for product design, pricing strategy, and long-term Medicare positioning. Audit, Governance & Compliance * Serve as… more
- Humana (Austin, TX)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more