- 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
- Centene Corporation (Raleigh, NC)
- …management of department overseeing compliance with regulations and laws related to Medicare line of business, which includes implementation of elements of an ... effective compliance program related to specific operational areas. Oversee the development of risk... areas. Oversee the development of risk assessments and oversight and monitoring work plans pertaining to those areas.… more
- Molina Healthcare (Boise, ID)
- …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 (St. Petersburg, FL)
- …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 (Austin, TX)
- …and laws related to Risk Adjustment across our Marketplace, Medicaid and Medicare lines of business, which includes implementation of elements of an effective ... compliance program. Oversee the development of risk assessments oversight and the monitoring work plans pertaining to Risk Adjustment. Partners with business areas… 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
- Corewell Health (Grand Rapids, MI)
- …Supports (LTSS) is a senior leadership role responsible for the strategic and operational oversight of long-term services and supports across the organization. ... Job Summary The Director , Highly Integrated Dual Eligible Special Needs (HIDE-SNP)...of Utilization Management. Essential Functions Strategic Leadership & Program Oversight : + Develop and implement operational plans… more
- Blue KC (Kansas City, MO)
- …of appropriate clinical documentation and quality coding. + Provide Government Programs oversight to ensure Medicare Advantage and ACA Risk Adjustment and ... and maintain the risk adjustment roadmap which defines the strategic initiatives, operational timelinesand regulatory audit and oversight functions to meet risk… more
- SERV Behavioral Health System (Hamilton, NJ)
- …and life satisfaction through a wide range of services. JOB SUMMARY: The Senior Director of IDD and Mental Health Services is a strategic and operational ... Operating Officer of SERV BHS Inc. This role provides executive-level oversight to ensure the delivery of high-quality, person-centered, and recovery-focused… more
Recent Jobs
-
Cardiology Electrophysiology Physician
- HCA Healthcare (Pensacola, FL)
-
Licensed Vocational Nurse
- Sevita (Garden Grove, CA)
-
Industrial Hygiene Technician- Asbestos, Lead, and/or Mold
- Atlas (Avon, MA)
-
Team Member (WA)
- Taco Bell (Yakima, WA)