- 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 ... 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 (Rochester, NY)
- …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 (Yonkers, NY)
- …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 (Yonkers, NY)
- …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
- Centene Corporation (Queens, NY)
- …is critical in managing end-to-end provider engagement, contract modeling, and performance oversight for Medicare Advantage and Dual Eligible Special Needs Plans ... incentive programs, attribution logic, and provider engagement strategies. + Represent Medicare VBP in governance discussions and escalate operational issues… more
- Humana (Albany, NY)
- …efforts that enhance both provider and patient experience. **Governance & Delegation Oversight ** The Clinical Director will participate in governance committees ... part of our caring community and help us put health first** The Clinical Director is a key member of the regional clinical leadership team responsible for executing… more
- Albany Medical Center (Albany, NY)
- …leadership. The Director oversees and leads the day to day operational , programmatic, financial, and employee related activities, as applicable, under the System ... Day (United States of America) Salary Range: $133,724.95 - $213,959.93 The Director is responsible for overseeing as well as implementing, developing, maintaining,… more
- New York State Civil Service (NY)
- …HELP No Agency People With Developmental Disabilities, Office for Title Deputy Director DDSO 2, Bridge Deputy Director Occupational Category Other Professional ... leader who can execute strategic decisions to serve as the Bridge Deputy Director of the Developmental Disabilities State Operations Office in Region 6 (DDSOO 6… 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
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