- Molina Healthcare (San Antonio, TX)
- …standards and requirements established by the Centers for Medicare and Medicaid . **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the ... within a managed care setting. **Preferred Education** Bachelor's degree Previous Director experience. To all current Molina employees: If you are interested… more
- Molina Healthcare (San Antonio, TX)
- …Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + Previous leadership ... Current State Medical License without restrictions (free of sanctions from Medicaid or Medicare) **PREFERRED EDUCATION:** Master's in Business Administration, Public… more
- CVS Health (Austin, TX)
- …within Network; Examples include ensuring data standards are synchronized across Medicaid and Medicare platforms, ensuring duals workflows are support across ... experience in strategy and delivery leadership roles + 5+ years of Medicare/ Medicaid and/or Duals experience + Proven success navigating large scale cross functional… more
- Centene Corporation (Austin, TX)
- …and managing performance of staff. Managed care, insurance, Medicare or Medicaid experience preferred. Experience with provider performance, provider engagement, and ... provider satisfaction highly preferred. Pay Range: $145,100.00 - $268,800.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus… more
- Humana (Austin, TX)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information,… more
- BrightSpring Health Services (Harlingen, TX)
- …compliance with Company policies and procedures, state licensure and regulations, Medicaid and Medicare standards, as well as state reimbursement regulations + ... Leading case conferences and other client-related meetings + Chairing committees as appropriate, safety, infection control, incident review, and human rights committees + Facilitating communication and serving as a liaison between and among nursing and direct… more
- Centene Corporation (Austin, TX)
- …with regulations and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of ... an effective compliance program. Oversee the development of risk assessments oversight and the monitoring work plans pertaining to Risk Adjustment. Partners with business areas to ensure and implement effective prevention, detection and correction of… more
- Molina Healthcare (Fort Worth, TX)
- …with business and other IT teams to deliver successful and certifiable Medicaid Management Information Systems solutions. * Works closely with EPMO, business ... stakeholders to manage priorities deliveries and expectations. **Job Qualifications** **Required Education** Graduate Degree or equivalent combination of education and experience **Required Experience** 7-9 years Application Design, Development Experience and,… more
- Prime Therapeutics (Austin, TX)
- …management. Enforces teamwork across all internal departments, as well as with Medicaid Clients, and an in-depth understanding of all rebate programs, trends, and ... state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each...auditors for yearly SOC-1 audit. + Works directly with Director to fulfill OIG and CMS audit requests. +… more
- Intermountain Health (Austin, TX)
- …and other administrative functions for the Medical Staff, Medical Director , Administration, and Allied Health Professionals. **Essential Functions** + Participates ... payer re-credentialing requests and demographic/roster requests. + Completes out-of-State Medicaid individual and facility enrollments timely and accurately for… more