• Director , Operational

    Molina Healthcare (Cleveland, OH)
    …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 (08/19/25)
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  • Senior Analyst, Operational Regulatory…

    Molina Healthcare (OH)
    …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 (08/22/25)
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  • Director , Medicare Segment…

    Molina Healthcare (Columbus, OH)
    **Job Description** **Job Summary** Leads and directs Molina Medicare segment leaders who are responsible for the development and administration of Medicare ... **Job Duties** + Enable market P&L success through support and oversight for assigned markets, including D-SNP market performance management. + Function… more
    Molina Healthcare (09/07/25)
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  • Program Director - Medicare Duals…

    Molina Healthcare (Columbus, OH)
    …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 (08/22/25)
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  • Director , Provider Network Management…

    Molina Healthcare (Cincinnati, OH)
    …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 (08/20/25)
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  • Director , Financial Planning & Analysis…

    Humana (Columbus, OH)
    …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
    Humana (08/26/25)
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  • Program Director (Workforce Development)…

    Molina Healthcare (OH)
    …abilities; ability to handle multiple priorities and deal with ambiguity; provide oversight over the strategic and operational programs; manage strategic ... **JOB DESCRIPTION** **JOB SUMMARY** : The Program Director leads strategic initiatives to enhance the direct...+ Manages programs using staff and matrixed resources with oversight from AVP and VP as needed + Develop,… more
    Molina Healthcare (09/08/25)
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  • Manager Network Operations

    OhioHealth (Columbus, OH)
    …the Central Verification Office (CVO) and Network Operations Department reports to the Director of CVO and Network Operations and oversees all operational ... credentialing. Responsibilities include adherence to accrediting body regulations; management oversight to staff; and establishing, organizing, and implementing procedures… more
    OhioHealth (08/21/25)
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  • Healthcare Compliance Auditor - Enterprise Risk

    Bon Secours Mercy Health (Cincinnati, OH)
    …hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Summary** Works collaboratively with the Compliance Manager on ... specific to hospital revenue cycle risk areas highlighted by the OIG, Medicare , State Medicaid, State Insurance Fraud; Managed Care or Governmental Value-Based… more
    Bon Secours Mercy Health (09/08/25)
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  • AVP, Encounters

    Molina Healthcare (Cincinnati, OH)
    …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
    Molina Healthcare (08/22/25)
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