- Molina Healthcare (ID)
- …relative to Molina Medicare . The Director will participate with the Molina Medicare Compliance Committee. The Director , working with the MHI VP ... Compliance , is accountable to the Molina Medicare Compliance Committee for all ...implementation and maintenance of the Molina Medicare Compliance Plan and audit activities. The Director … more
- Humana (Boise, ID)
- …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 (Boise, ID)
- …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 (Boise, ID)
- …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
- Molina Healthcare (Meridian, ID)
- …or related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with ... **Job** ** ** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module...entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the… more
- Molina Healthcare (ID)
- …of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops ... infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and… more
- Molina Healthcare (Caldwell, ID)
- …experience in Medicare , DSNP and CSNP population, Enrollment, A&G, Claims, Compliance , or other Operations experience To all current Molina employees: If you are ... and resolve **Knowledge/Skills/Abilities** Responsible for the oversight of regulatory compliance of Corporate Operations functions, including but not limited to… more
- Molina Healthcare (ID)
- …of Coverage for print and online distribution via the iCat authoring process, ensuring compliance with CMS guidelines. Support Medicare and MMP line of business ... completion including adhoc projects and submissions as assigned by the Director of Medicare Programs. **KNOWLEDGE/SKILLS/ABILITIES** + Initiate projects by… more
- Molina Healthcare (Boise, ID)
- …demonstrate compliance to regulatory requirements. * Supports Manager and Director with developing the Operational Oversight Work Plan, monitoring and reporting ... assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Analyst develops and… more
- Humana (Boise, ID)
- …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
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