- Molina Healthcare (Lexington, KY)
- …operation process designs and establishes procedures and techniques for operational standards. Confers with customers to define and resolve ... **Knowledge/Skills/Abilities** Responsible for the oversight of regulatory compliance of Corporate Operations functions, including but not limited to performance of… more
- Molina Healthcare (KY)
- …compliance by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the standards and ... related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with CMS CTM… more
- Molina Healthcare (Lexington, KY)
- …and regulations, contract provisions, and internal policies and procedures. * Supports the Operational Oversight Manager, Director , and team in the general ... reporting exists to demonstrate compliance to regulatory requirements. * Supports Manager and Director with developing the Operational Oversight Work Plan,… more
- Molina Healthcare (Owensboro, KY)
- …to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight , monitoring ... and implements process improvements to achieve member/provider satisfaction or operational effectiveness/efficiencies which contribute to Molina Medicare 's… more
- Molina Healthcare (Covington, KY)
- …and implements process improvements to achieve member/provider satisfaction or operational effectiveness/efficiencies which contribute to Molina Medicare 's ... for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible...DSNP, HIDE, FIDE, EAE, AIP, etc. * Provides direct oversight , monitoring and training of provider disputes and appeals… more
- Humana (Frankfort, KY)
- …rules, regulations, and sub-regulatory guidance applicable to insurance products, including Medicare Advantage, Part D, Group Specialty, and Individual Specialty, as ... capabilities intersect and collaborate across various departments. The Associate Director of Insurance Product Compliance provides expert consultation and research… more
- Humana (Frankfort, KY)
- …our caring community and help us put health first** The Associate Director , Compliance ensures compliance with governmental requirements. The Associate Director , ... required to work in either Central or Eastern Time. Associate Director , Regulatory Intake Compliance is responsible for enterprise-wide regulatory monitoring,… more
- BrightSpring Health Services (Louisville, KY)
- …3rdParty Payor contracting process for LTC PharMerica business unit. This includes Medicare Part D, Commercial and Managed Medicaid. + Manage and negotiate national ... managing GER, BER and reconciliation processes. + Responsible for financial oversight of the department including underwriting and auditing of all potential… more
- Molina Healthcare (Lexington, KY)
- …in collaboration with the Manager or Director . * Keeps Manager or Director apprised of operational issues, including staffing resources, program and system ... drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics with regard to patient… more
- Molina Healthcare (KY)
- …strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core ... contracts. Issue escalations, network adequacy, Joint Operating Committees, and delegation oversight . Tighter knit proximity ongoing after contract. * In conjunction… more
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