- BioBridge Global (San Antonio, TX)
- …of controlled documents and record retention. Must maintain familiarity of regulatory /quality compliance , to include Federal and State regulations, ISO, ... Quality Management, oversee the business continuity and risk & compliance program to ensure the organization is prepared for...will be performed with support from Global Quality and Regulatory leadership. Commit to and abide by the character… more
- Molina Healthcare (TX)
- …+ Review Medicaid COB claims for correct secondary pricing logic and compliance with configuration and regulatory rules. + Analyze claim outcomes ... our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing. This role… more
- Molina Healthcare (Dallas, TX)
- …the Delegation Oversight Department. Oversees delegated activities to ensure compliance requirements including delegation standards and requirements contained in the ... Molina Medical Compliance and Fraud, Waste and Abuse Program. **KNOWLEDGE/SKILLS/ABILITIES** +...of education and experience. **Required Experience** + 3+ years managed care experience. + Min. 1 year experience completing… more
- Molina Healthcare (Houston, TX)
- …execute comprehensive Medicare strategies aligned with enterprise goals and regulatory requirements. + Design and implement state-specific and product-specific ... and retention. + Analyze market trends, competitive intelligence, and regulatory changes to inform strategic decisions. + Lead high-priority, cross-functional… more
- Molina Healthcare (El Paso, TX)
- …other Molina departments as needed + Writes narrative reports to interpret regulatory specifications, explain programs and results of programs, and document findings ... education and work experience. + 3 years' experience in healthcare with a minimum of 2 years' experience in...of 2 years' experience in health plan member interventions, managed care, or equivalent experience. + Demonstrated solid business… more
- Molina Healthcare (San Antonio, TX)
- …appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) ... knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and… more
- Molina Healthcare (TX)
- …conducts, and documents pre-delegation, ongoing and annual assessments to determine compliance with delegated functions. * In conjunction with enterprise delegation ... tracks corrective action plans for any delegates identified as out of compliance with delegated responsibilities including timely follow-up actions related to the… more
- Molina Healthcare (Fort Worth, TX)
- …that support continuous quality improvement of the provider database, compliance with regulatory /accreditation requirements, and Network Management business ... equivalent combination of education and experience **Required Experience** + 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider… more
- Molina Healthcare (Fort Worth, TX)
- …and in compliance with all relevant federal, state, and local regulatory requirements. **Job Duties** + Leads and supports integrated duals overall business and ... + Coordinates accountabilities between duals office and shared service to drive compliance and efficiency as well as provide oversight, including service level… more
- Molina Healthcare (Fort Worth, TX)
- **JOB DESCRIPTION** **Job Summary** Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and ... management, and/or transition of care activities to assist Molina Healthcare members with their healthcare needs. Care...align with the model of care and that meet regulatory requirements. + Manages staff caseloads and assigns cases… more