- State of Colorado (Denver, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... Associate Director of Data Governance Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4961397) Apply Associate Director of Data Governance… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Director Governmental Reporting is responsible for ensuring that Houston Methodist meets all internal and external financial and ... governmental reporting requirements. Requirements include Medicare cost reports, Federal Tax Returns Health and Human Services (HHS)/Centers for Medicare and… more
- CVS Health (Hartford, CT)
- …of our members' health care and social determinant needs. The Case Management (CM) Medical Director will participate in executing and deploying our Models of ... member outreach when warranted. * Provides clinical review and adjudication of MCR Appeals case when needed * Professional Development: oversee and manage 1 Regional… more
- Evolent (Cheyenne, WY)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... care delivery.** + Offer **clinical rationale for standard and expedited appeals ,** ensuring compliance with UM policies and regulatory requirements. + Collaborate… more
- Trinity Health (Gaithersburg, MD)
- …The Director , Quality Improvement and Compliance, in collaboration with the Medical Director , is responsible for developing and implementing the annual QI ... implement the annual Quality Improvement (QI) Plan with the Medical Director + In conjunction with ...compliance with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance Program.… more
- Alameda Health System (Oakland, CA)
- …and assists physicians with appeals . Maintains minimal denial rates by Medicare , MediCal , private and contracted payers through appropriate direction of ... Director , Utilization Management + Oakland, CA + Highland...the utilization of healthcare services, including appropriateness, efficiency, and medical necessity of treatments and procedures. + Analyze data… more
- UTMB Health (Galveston, TX)
- Director of Hospital Accounts Receivable **Galveston, Texas, United States** **New** Executive UTMB Health Requisition # 2503906 **Summary:** The Director of ... Billing, Collections, Customer services, Denial Management and Budget preparation. The Director ensures accurate and timely billing and collection of all Hospital… more
- CVS Health (Scottsdale, AZ)
- …And we do it all with heart, each and every day. As the Lead Director of Market Conduct Exams for the Network Services area, you will have the opportunity ... pertaining to PBM network comprehensive activities. In this role the Lead Director will be responsible for developing our internal (Government Affairs) and external… more
- Catholic Health Services (West Islip, NY)
- …limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure ... Overview The Director of Care Management is responsible for providing...Provides guidance and education to the Care Coordination department, Medical Staff, and SCSH Administrative Staff. Ensures compliance with… more
- Somatus (Mclean, VA)
- …provides guidance and oversight to all lines of business including Commercial, Medicaid, Medicare , and Special Need Plans (SNPs). The Director , Quality will work ... the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Flexible Paid Time Off (PTO) + Professional… more