- Humana (Concord, NH)
- …community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. The Behavioral ... Health Medical Director work assignments involve moderately complex to complex issues...authorized. All work occurs within a context of regulatory compliance and work is assisted by diverse resources which… more
- Humana (Lansing, MI)
- …of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests for services. The ... Medical Director work assignments involve moderately complex to complex issues...authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which… more
- Humana (Topeka, KS)
- …our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. ... The Corporate Medical Director works on problems of diverse scope and complexity...necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD… more
- Humana (Honolulu, HI)
- …our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The ... Corporate Medical Director works on problems of diverse scope and complexity...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents… more
- Humana (Lansing, MI)
- …diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and monitors ... for our Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of… more
- Community Health Systems (La Follette, TN)
- …are submitted in accordance with regulatory guidelines and organizational policies. The Medicare Billing Specialist supports compliance with federal and state ... **Job Summary** The Medicare Billing Specialist is responsible for performing timely...Ensures documentation and billing practices align with audit and compliance expectations. + Escalates unresolved billing issues or delays… more
- Commonwealth Care Alliance (Boston, MA)
- …of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible for the ... Medicare , and commercial payment methodologies and supports audit, compliance , and provider engagement initiatives. This role also provides support in… more
- UTMB Health (Galveston, TX)
- …appropriate processes and procedures to ensure compliance with Medicare and Medicaid regulations. + Supports Director , Finance-Government Reimbursement ... Associate Director of Finance - Government...government payor reimbursement-related calculations and estimates and ensures UTMB compliance with Medicare and Medicaid regulations. **Scope:**… more
- SUNY Upstate Medical University (Syracuse, NY)
- …resources. Ensure accurate coding and documentation to support quality initiatives and Medicare compliance . Work closely with clinical teams across seven Primary ... Nurse (RN), or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) across seven Primary Care clinics. This role… more
- Molina Healthcare (Caldwell, ID)
- …demonstrate compliance to regulatory requirements. * Supports Manager and Director with developing the Operational Oversight Work Plan, monitoring and reporting ... to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Sr. Analyst develops and… more