- Molina Healthcare (Atlanta, GA)
- …relative to Molina Medicare . The Director will participate with the Molina Medicare Compliance Committee. The Director, working with the MHI VP Compliance ... , is accountable to the Molina Medicare Compliance Committee for all Medicare compliance related activities including but not limited to the development,… more
- Molina Healthcare (Macon, GA)
- **Job Description** **Job Summary** Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and ... the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations. **Knowledge/Skills/Abilities**… more
- Molina Healthcare (Savannah, GA)
- …or related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with ... **Job** ** ** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM… more
- Humana (Atlanta, GA)
- … compliance on this complex and expanding areas. In addition, this role supports compliance of Medicare bid filings and allows you to see the overall end ... us put health first** The Lead Actuary, Risk and Compliance is responsible for the overall management and oversight...to end bid process at a leading Medicare Advantage organization. This is a great role for… more
- Humana (Atlanta, GA)
- …Professional 2 working remote anywhere in the US. This team focuses on Medicare compliance and operational communications. As the Production Professional 2, you ... Communications Professional who is experienced in print communications and Medicare to join the Retail Communications Team as a...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Elevance Health (Atlanta, GA)
- …of managerial experience is strongly preferred + Experience with IRE/Maximus and Medicare compliance , programs, guidelines, and processes are strongly preferred. ... and operational and plan risk, ensures quality, and regulatory compliance . This role specifically oversees the IRE Team. **How...regulated audits. + Oversight of the IRE portions of Medicare audits and universe production. + Serves as a… more
- Sedgwick (Atlanta, GA)
- …and laws + Knowledge of medical terminology for claim evaluation and Medicare compliance + Knowledge of appropriate application for deductibles, sub-limits, ... SIR's, carrier and large deductible programs. + Strong oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Strong organizational skills + Strong interpersonal skills + Good negotiation skills +… more
- Prime Therapeutics (Atlanta, GA)
- …our passion and drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs - Remote, Pennsylvania **Job Description** Manages the ... coordination of benefits in the pharmacy program with Medicare Part D plans. Provides the technical and leadership skills that ensure successful Part D pharmacy… more
- CVS Health (Atlanta, GA)
- …We are seeking a strategic and technically proficient leader to oversee Medicare data science initiatives supporting actuarial analytics and pricing. The ideal ... deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies. This...end-to-end bid cycle process, including pricing, forecasting, and regulatory compliance . + Serve as a subject matter expert on… more
- Humana (Atlanta, GA)
- …service should be authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which may include national clinical ... teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to… more