- Molina Healthcare (NY)
- …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 (Albany, NY)
- …compliance by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the standards and ... you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer partners… more
- Robert Half Finance & Accounting (New York, NY)
- …service agreements with brokers, presenting recommendations for approval to the HSO. Claims and Administrative Oversight + Works alongside Finance and Legal ... claims incidents, providing monthly insights to the Finance Director and Claims Manager, along with strategic...+ Dedication to accessibility and ongoing consultation for continuous operational support. Robert Half is the world's first and… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Director of Contract Compliance will oversee the contract compliance program, ensuring the organization's contracts, specifically related to ... contract compliance monitoring, risk identification, and issue resolution. The Director will collaborate with various internal departments, including legal, finance,… more
- City of New York (New York, NY)
- …comparable civil service title.* Reporting to the Chief Operating Officer, the Director of Disability Retirement Services will lead the Division, providing strategic ... oversight for the processing of disability and accidental death...transformative improvements in service delivery including case management. The Director will champion a results-oriented approach, integrating innovative practices… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …implementation of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has overall accountability for BH services ... interdisciplinary complex care management rounds. + Provision of clinical oversight and leadership to Utilization Management/Case Management (UM/CM) staff working… more
- GuideOne Insurance (New York, NY)
- As the Director of Enterprise Architecture, you will be responsible for leading the architecture strategy, governance, and execution across infrastructure, ... in driving governance and modernization initiatives across multiple domains. As the Director of Enterprise Architecture, you will lead the Architecture Review Board… more
- Molina Healthcare (Yonkers, NY)
- …plans to include DSNP, HIDE, FIDE, EAE, AIP, etc. * Provides direct oversight , monitoring and training of provider disputes and appeals to ensure adherence with ... with Customer/Member services, Provider Services, Sales, Enrollment, UM, Case Management, Claims , and other departments within Molina Medicare and Medicaid regarding… more
- Kyndryl (New York, NY)
- …large-scale transformation programs across Insurance clients in areas such as operational excellence, claims automation, risk mitigation and technology ... Promoter Score (NPS) and new relationship development; Secure client references Operational Excellence: *Achieve individual and team utilization targets *Lead the… more
- Kyndryl (New York, NY)
- …large-scale transformation programs across Insurance clients in areas such as operational excellence, claims automation, risk mitigation and technology ... Net Promoter Score (NPS) and new relationship development; Secure client references Operational Excellence: + Achieve individual and team utilization targets + Lead… more