- Molina Healthcare (Santa Fe, NM)
- …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 (NM)
- …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 (Albuquerque, NM)
- …Summary** Leads and directs team that provides strategic, process improvements, and operational support to advance the goals and objectives of the Integrated Duals ... Duals, members of the market leadership team, responsible for optimizing operational departments, programs, and services in alignment with Molina Healthcare's… more
- Molina Healthcare (Santa Fe, NM)
- …abilities; ability to handle multiple priorities and deal with ambiguity; provide oversight over the strategic and operational portfolios; manage strategic ... Program Management professional. Responsible for overall governance across all operational and strategic portfolio of projects; strong management and leadership… more
- Molina Healthcare (Albuquerque, NM)
- …on increased responsibility and adding value to the organization + Ensures strong operational processes are in place to deliver across all areas of responsibility + ... Provides oversight analyses of demographic data to support accurate Network Adequacy Reporting and Directory development. + Manage multiple resources and projects… more
- Molina Healthcare (Rio Rancho, NM)
- …speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. + Ensures that adequate staffing coverage is ... all times of operation. + Assists pharmacy leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually… more
- Prime Therapeutics (Santa Fe, NM)
- …drives every decision we make. **Job Posting Title** Clinical Account Director Remote **Job Description** **This is an Individual Contributor/Client Facing Role.** ... The Clinical Account Director is responsible for the management of all client's...&Therapeutics (P&T) or business committee decision making and implementation, oversight of formulary publications, oversight of formulary… more
- Humana (Santa Fe, NM)
- …and other data to provide accurate and timely information for strategic and operational decisions. The Director , Financial Planning & Analysis requires an ... **Become a part of our caring community and help us put health first** The Director , Financial Planning & Analysis analyzes and forecasts financial, economic,… more
- Molina Healthcare (Las Cruces, NM)
- …Encounters is responsible for establishing enterprise-wide strategy, governance, and oversight of processes that track, evaluate, and submit encounter deletions ... for Medicare Advantage, ACA, and Medicaid lines of business. This...accuracy & completeness (ie, Encounter Production, Audit, Production Vendor Oversight ) for assigned lines of business. Responsible for increasing… more
- Intermountain Health (Santa Fe, NM)
- …performance levels are met, handle complex items, and support the OSP Director on strategic and operational projects. Key responsibilities include negotiating ... contracts, ensuring compliance with institutional and external regulations, and providing oversight of the contract administration process. This position will work… more
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