- Trinity Health (Pensacola, FL)
- …+ Ensure compliance with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance Program. Assure annual review ... Plan for the PACE Organization (PO) and ensure overall CMS regulatory compliance . The Director, Quality Improvement and Compliance , in collaboration with… more
- Molina Healthcare (Jacksonville, FL)
- **JOB DESCRIPTION** **Job Summary** Molina Healthcare's Compliance team supports compliance operations for all Molina product lines enterprise wide. It is a ... centralized corporate function supporting compliance activities at individual state...+ Performs Plan Required Reporting. + Interpret and analyzes Medicare , Medicaid and MMP Required Reporting Technical Specifications. +… more
- Centene Corporation (Tallahassee, FL)
- …in the Continental United States.** **Position Purpose:** Supports the Risk Adjustment Compliance program elements, with a focus on the auditing and monitoring ... with business areas to ensure effective prevention, detection, and correction of compliance issues. Facilitates and leads external audits related to Risk Adjustment… more
- Prime Therapeutics (Tallahassee, FL)
- …administration, and execution of strategic plans that advance Prime's position in the Medicare space. This position has accountability for the Medicare P & ... L, and provides oversight to the development, maintenance, and growth of Medicare products and services, and it ultimately responsible for driving growth of the … more
- Humana (Tallahassee, FL)
- …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 ... the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All work occurs… more
- Molina Healthcare (Tampa, FL)
- **Job Description** **Job Summary** Provides leadership to the Medicare Duals team and plays a critical role in advancing the Medicare Integrated Duals segment ... strategic priorities. Develops and executes Medicare strategies, including state-specific and product-specific growth initiatives. Leads high-priority projects… more
- Humana (Oviedo, FL)
- …to the development, implementation, and management of the company's Medicare /Medicaid Five-Star Quality Rating System. The Senior Stars Improvement, Clinical ... Organizations (MSOs) and organizational leaders to impact Centers for Medicare & Medicaid Services (CMS) Star Rating categories -...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Tallahassee, FL)
- …service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national ... internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to… more
- Humana (Tallahassee, FL)
- …customers at the center of everything it does. Are you passionate about the Medicare population, looking for a role in management with the ability to directly impact ... self-driven individuals to join our team. Our Senior Manager, Medicare Sales, motivates and drives a team of ...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Molina Healthcare (Orlando, FL)
- …and compliance to SVP, Clinical Operations and CMO, Enterprise Medicare Unit, + Develops strategic direction for Star Rating improvement through ongoing ... existing healthcare quality improvement initiatives and education programs supporting Medicare Star Ratings improvement for Clinical HEDIS measures. Responsible for… more
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