- Highmark Health (Harrisburg, PA)
- …A key responsibility is the creation, revision and management of spreadsheets related to Medicare coverage analysis and compliance with Medicare rules and ... Health Network **Job Description :** GENERAL OVERVIEW: Responsible for the Medicare Coverage Analysis (MCA) for sponsored projects within WPAHS, budget development… more
- Fallon Health (Springfield, MA)
- …in our service area, and who have MassHealth Standard, and may have Medicare . It combines MassHealth (Medicaid) and Medicare benefits, including prescription ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief summary of purpose:**… more
- Molina Healthcare (Austin, TX)
- …with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal , state, and local regulatory requirements. ... + Coordinates accountabilities between duals office and shared service to drive compliance and efficiency as well as provide oversight, including service level… more
- Amazon (San Francisco, CA)
- …quality performance for One Medical Seniors throughout the country, focusing on Medicare Advantage Stars and ACO REACH programs, driving excellence in healthcare ... improve the quality of care delivered for Senior Health, as measured by HEDIS, Medicare Advantage Stars, ACO REACH, and other national quality metrics. - Design and… more
- CVS Health (Lansing, MI)
- …processes, procedures, and systems to ensure consistent results and organizational compliance with regulations related to the organization's Medicare Part ... business projects and programs and managing operations within the Medicare Part B Pharmacy Team. You will act as...will be considered for employment in accordance with all federal , state and local laws. We are an equal… more
- Humana (Lansing, MI)
- …for our Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of ... Chief Medical Officer. POSITION RESPONSIBILITIES: + Keeps current with State and Federal regulations regarding the practice of Pharmacy and implements changes as… more
- Molina Healthcare (Caldwell, ID)
- …to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Sr. Analyst develops ... and performs oversight audits and validation activities to ensure operational regulatory compliance with Federal and State laws and regulations, contract… more
- Humana (Honolulu, HI)
- …appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana ... experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Topeka, KS)
- …medical necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD represents ... experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- CVS Health (Columbus, OH)
- …with heart, each and every day. **Position Summary** Contributes to the Medicare Dental product portfolio, conducting market analysis and driving new product ... cross-functional collaboration. Drives innovation, evaluates performance, and ensures regulatory compliance , playing a pivotal role in guiding the organization's… more