- 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
- Ankura (New York, NY)
- …, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment. The Senior Director ... following types of activities: + Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance , audit, and investigation projects… more
- Trinity Health (Pensacola, FL)
- …Improvement Plan for the PACE Organization (PO) and ensure overall CMS regulatory compliance . The Director , Quality Improvement and Compliance , in ... including leading quality initiatives and projects. In addition, the Director ensures that data is collected from appropriate sources,... with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance… more
- AdventHealth (Maitland, FL)
- …local and industry standards, guidelines, rules and regulations to ensure compliance . + Manages department team members by providing application assistance and ... day operations. + Works reports daily, maintaining established goal(s), and notifies Director , of issues preventing achievement of such goal(s). Manages the follow… more
- Humana (Denver, CO)
- …a part of our caring community and 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 /Medicaid and Waiver requests. The Medical Director ...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All… more
- UTMB Health (Galveston, TX)
- …appropriate processes and procedures to ensure compliance with Medicare and Medicaid regulations. + Supports Director , Finance-Government Reimbursement ... government payor reimbursement-related calculations and estimates and ensures UTMB compliance with Medicare and Medicaid regulations. **Scope:** Institutional… more
- Humana (Montgomery, AL)
- …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (San Juan, PR)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Humana (Washington, DC)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... at the Inpatient level. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national clinical… more
- BAYADA Home Health Care (Sterling, VA)
- …candidate will have a strong background in healthcare administration, regulatory compliance ( Medicare Conditions of Participation), clinical coordination, and ... **Join BAYADA as a Home Health Director - Falls Church, VA** Are you ready...:** + Provide leadership and strategic direction to ensure compliance with Medicare regulations and state/federal laws… more