- City of New York (New York, NY)
- …and employees on a variety of topics, including legal ethics, conflicts, privileges, federal grants, Medicare compliance , and outside employment. Division ... position of Assistant Corporation Counsel in the Ethics & Compliance Division. Attorneys with more than five years of...Senior Counsel position in the division. The Ethics & Compliance Division has counseling and ligation adjacent roles and… more
- CVS Health (Austin, TX)
- …And we do it all with heart, each and every day. **Position Summary** The ** Medicare Compliance Consultant** is a compliance role that supports the ... and under the direction of - the health plan, Medicare Compliance Officer, and other team members,...will be considered for employment in accordance with all federal , state and local laws. We are an equal… more
- Medical Mutual of Ohio (OH)
- …responsible for leading the implementation and day-to-day management of Medical Mutual's Medicare Compliance Program, which supports both Medicare Advantage ... Manages the implementation and operation of the Medical Mutual Medicare Compliance Program. + Serves as Medical...Skills and Knowledge:** + Strong knowledge of Statutory and Federal laws and Regulations that affect our various company… more
- Commonwealth Care Alliance (Boston, MA)
- …& Audits Sr. Specialist II is responsible for ensuring CCA's operational compliance with state and federal healthcare regulations, particularly MassHealth ... (Massachusetts Medicaid) and CMS Medicare requirements. This role is housed within the Claims...regulatory audits and maintaining alignment with evolving state and federal requirements. Supervision Exercised: * No, this position does… more
- Molina Healthcare (Grand Island, NE)
- …with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal , state, and local regulatory requirements. ... **Job Description** **Job Summary** Leads and directs Molina Medicare segment leaders who are responsible for the...Monitor and support sales and retention efforts. + Monitor compliance and regulatory risks. + Contribute to and present… more
- Highmark Health (Charleston, WV)
- …models. This job is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue streams and provides strategic, hands-on, office ... based support to PCPs for analysis of performance Medicare STARS, Medicaid HEDIS and risk revenue streams, identifies...includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well… more
- CVS Health (Dover, DE)
- …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
- The Cigna Group (Bloomfield, CT)
- …position will provide external actuarial analytics support within the regulated Medicare market and Pharmacy Benefit Manager (PBM) Healthplan space. This actuarial ... a designated full time support to Express-Script's external client's Medicare Part D business. This role will matrix with...Bid Development, Desk Review & Audits + CMS Regulatory Compliance / Reporting + Financial Reconciliation Modeling + Trend… more
- Community Health Systems (La Follette, TN)
- …guidelines and organizational policies. The Medicare Billing Specialist supports compliance with federal and state billing regulations and assists in ... **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
- Prime Therapeutics (Harrisburg, PA)
- …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