- Humana (Lansing, MI)
- …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
- CVS Health (Lansing, MI)
- …We are seeking a strategic and technically proficient leader to oversee Medicare data science initiatives supporting actuarial analytics and pricing. The ideal ... deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies. This...end-to-end bid cycle process, including pricing, forecasting, and regulatory compliance . + Serve as a subject matter expert on… more
- Humana (Lansing, MI)
- …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 (Ann Arbor, MI)
- …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
- Humana (Lansing, MI)
- …diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and monitors ... for our Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of… more
- Molina Healthcare (Warren, MI)
- …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 (Ann Arbor, MI)
- …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
- Henry Ford Health System (Troy, MI)
- …and planning and marketing support. Coordinate the development and implementation of Medicare Advantage sales strategies, compliance activities and oversight for ... GENERAL SUMMARY: Responsible for the retention and growth of the Medicare line of business (both Individual and Group) accounting for more than $400 million in… more
- Molina Healthcare (Sterling Heights, MI)
- …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 (Lansing, MI)
- …of our caring community and help us put health first** The Associate Director , Compliance ensures compliance with governmental requirements. The Associate ... Director , Compliance requires a solid understanding of how organization capabilities...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
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