- Molina Healthcare (Columbus, OH)
- **Job Description** **Job Summary** Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and ... the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations. **Knowledge/Skills/Abilities**… more
- CVS Health (Columbus, OH)
- …care objectives. Working cross-functionally with Duals Center of Excellence, clinical, compliance , analytics and network teams, the Senior Manager drives ... Leads the strategy, design, development and life cycle management of Aetna Medicare products that serve Medicare Advantage populations, including Chronic Care… more
- Molina Healthcare (OH)
- …Enrollment activities (along with other Core Ops areas of responsibilities) within Medicare and Medicaid. Role is predicated on building relationships with vendors, ... vendor performance involving onshore and offshore resources, monitors regulatory compliance adherence (in conjunction with functional counterparts) and quality… more
- Molina Healthcare (OH)
- …business areas and owners to ensure processes and reporting exists to demonstrate compliance to regulatory requirements. * Supports Manager and Director with ... to assess, oversee, and recommend business practices to ensure adherence to and compliance with State and Federal regulatory guidelines. The Sr. Analyst develops and… more
- Molina Healthcare (OH)
- …integration, and a strong understanding of data governance and compliance in healthcare environments. **Knowledge/Skills/Abilities:** * Architect and implement ... Deploy, monitor, and troubleshoot Hadoop-based infrastructure using tools such as Cloudera Manager , Ambari, and Zookeeper. * Enforce data quality, security, and … more
- Cardinal Health (Columbus, OH)
- …of the annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory responsibility for all Compliance Audit staff. **_What is ... **_What Ethics & Compliance contributes to Cardinal Health_** Ethics & ...facility fee coding and auditing. + Expert-level knowledge of Medicare and Medicaid documentation and coding rules and guidelines;… more
- Medical Mutual of Ohio (OH)
- …Advantage, Medicare Supplement, and individual plans. **Responsibilities** **PMO Project Manager I** Assists in leading enterprise projects and teams in ... compliance with the Company's defined project management standards with...education. . Performs other duties as assigned. **PMO Project Manager II** Leads enterprise projects and teams with support,… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …recognized for clinical and operational excellence. **Summary** Works collaboratively with the Compliance Manager on creating auditing protocols which align with ... auditing, or coding/billing either from a consulting perspective or as an employee/ manager required. + Demonstrated working knowledge of Medicare and Medicaid,… more
- Humana (Columbus, OH)
- …part of our caring community and help us put health first** The Manager , Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. ... The Manager , Fraud and Waste works within specific guidelines and...+ Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of experience with… more
- Molina Healthcare (Columbus, OH)
- …as needed + Primary point of contact for the internal partners, ie Medicare Administration, Compliance and Health Plan Operations. Coordinates and facilitates ... including goal setting and score card development + Monitors and enforces compliance with enterprise-wide processes and develops workflows for all staff to follow… more
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