- Gentiva (Fairfax, VA)
- …Hospice RN leadership, Director of Clinical Services jobs, Hospice nurse director , Hospice compliance RN, and Medicare Hospice regulations ReqID: ... Care. Transform Hospice Services.** We are seeking a RN Director of Clinical Services to join our team. Reporting...responsible for ensuring the appropriate delivery of hospice services, compliance with Medicare Hospice Benefit Conditions of… more
- CVS Health (CT)
- …highly regulated function, this role will also oversee delegated PBM functions, cross Medicare Pharmacy Organizational Compliance with CMS regulations as well as ... implementation and milestone tracking for business plans as Part of the Medicare benefit and product cycle. Directs the strategic development and implementation of… more
- Molina Healthcare (Vancouver, WA)
- …Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state, and local regulatory requirements. **Job ... markets, including D-SNP market performance management. + Function as Medicare subject matter expert and point of contact for...Monitor and support sales and retention efforts. + Monitor compliance and regulatory risks. + Contribute to and present… more
- CVS Health (CT)
- …remote based (work at home) based anywhere in the US. Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part ... and Utilization Management Strategy support * Collaborative work with Medicare Quality and Compliance on an ongoing basis * Develop subject matter expertise… 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 (Olympia, WA)
- …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
- CVS Health (Hartford, CT)
- …Summary** Provides strategic leadership and actuarial oversight for Aetna's Individual Medicare Part D business by coordinating bid development and submission ... collaborating with stakeholders to align financial goals with business objectives. Ensures Medicare Part D bids are actuarially sound, drives process development and… 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
- Molina Healthcare (Roswell, NM)
- …and resolve. **Knowledge/Skills/Abilities** Responsible for the oversight of regulatory compliance of Corporate Operations functions, including but not limited to ... performance of internal compliance audits, represent Corporate Operations on external regulatory or...a cadence for assessing and adjusting * Monitor internal compliance of Corporate Operations units via establishment of an… more
- Commonwealth Care Alliance (Boston, MA)
- …to the Director , Claims Operations & Quality Assurance, the Regulatory Compliance & Audits Sr. Specialist II is responsible for ensuring CCA's operational ... compliance with state and federal healthcare regulations, particularly MassHealth...federal healthcare regulations, particularly MassHealth (Massachusetts Medicaid) and CMS Medicare requirements. This role is housed within the Claims… more