- Molina Healthcare (St. Petersburg, FL)
- …Sales, Enrollment, UM, Case Management, Claims, and other departments within Molina Medicare and Medicaid regarding A&G operations and dependencies. * ... Summary** Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and… more
- CVS Health (Boston, MA)
- …team focused on enhancing pricing accuracy, optimizing bid strategies, and supporting Medicare operations through advanced analytics and actuarial insights. Key ... We are seeking a strategic and technically proficient leader to oversee Medicare data science initiatives supporting actuarial analytics and pricing. The ideal… more
- Elevance Health (Costa Mesa, CA)
- **Medical Director - Medicare and Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... as required by law. **Candidates must live in California.** The **Medical Director ** will be responsible for utilization review case management for Medicare… more
- Molina Healthcare (Albany, NY)
- …by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the standards and controls that ... building business cases and securing resources across IT, Compliance, Quality, and Operations to fund high-return enhancements. **Core** ** ** **Duties** 1. Case… more
- Humana (Lansing, MI)
- …diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and monitors ... for our Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of… more
- Molina Healthcare (Phoenix, AZ)
- …benefits, operations , communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops ... infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and… more
- Queen's Health System (Honolulu, HI)
- RESPONSIBILITIES Effective Date: 06/25 I. JOB SUMMARY: A Director functions at a high organizational level, providing leadership and direction in the development and ... problems and other needs and seeks solutions to assure the on-going operations of QHS. Is highly skilled in facilitating interactions among organizational… more
- Bristol Myers Squibb (Princeton, NJ)
- …personal lives. Read more: careers.bms.com/working-with-us . **Summary:** The Commercial & Medicare Channel Lead will manage forecasting and analytics for the ... Commercial and Medicare channels. This role coordinates inputs from various teams...close + Maintain ongoing relationships with contracting and rebate operations teams + Conduct adhoc analysis as required by… more
- Molina Healthcare (NY)
- …Responsible for the oversight of regulatory compliance of Corporate Operations functions, including but not limited to performance of internal ... compliance audits, represent Corporate Operations on external regulatory or associated audits, oversee function...years or more + 5 years of experience in Medicare , DSNP and CSNP population, Enrollment, A&G, Claims, Compliance,… 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 ... process for overseeing compliance with regulations and laws related to Medicare requirements + Provides guidance to various business departments regarding compliance… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …The Medicare Risk Adjustment Strategy Program Manager will report to the Senior Director of Medicare Risk Adjustment and Analytics. This role will manage the ... , financing and revenue generating programs + Knowledge of Medicare Part D program, operations and industry trends + Proven ability to work collaboratively… more
- Commonwealth Care Alliance (Boston, MA)
- …this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. ... This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for… more
- Commonwealth Care Alliance (Boston, MA)
- …of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible for ... will not be considered at this time._** **Position Summary:** Reporting to the Director , Claims Operations and Quality Assurance, the Claims Sr. Analyst plays… more
- AmeriHealth Caritas (Southfield, MI)
- …more about us at www.amerihealthcaritas.com. **Role Overview:;** Reporting to the Supervisor of Medicare LTSS Operations , the Medicare LTSS Care Coordinator ... needs. This role ensures that care is delivered by Centers for Medicare & Medicaid Services (CMS), state, and organizational guidelines, within the scope… more
- SUNY Upstate Medical University (Syracuse, NY)
- …the supervision of a licensed provider. The RN/CNS will report to the UUMAS Director of Quality and Practice Operations and collaborate closely with Primary Care ... Nurse (RN), or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) across seven Primary Care clinics. This role… more
- Henry Ford Health System (Troy, MI)
- …daily operations . Bring concerns and pending issues to the Director in a timely manner for balanced resolutions. EDUCATION/EXPERIENCE REQUIRED: + Bachelor's ... GENERAL SUMMARY: Responsible for the retention and growth of the Medicare line of business (both Individual and Group) accounting for more than $400 million in… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan is seeking a full-time Strategy Consultant to support the Medicare & SNP Product Department within the UPMC Insurance Services Division! The ... activities. + Manage projects from inception (business planning) through implementation (start-up operations ). + Complete projects in a timely manner. + Develop and… more
- BAYADA Home Health Care (Roxboro, NC)
- …Health Care is seeking an experienced and compassionate ** Director ** to manage operations at our Roxboro, NC ** Medicare -certified Home Health office** . The ... **Join BAYADA as a Home Health Director - Roxboro, NC** Are you ready to...Medicare Conditions of Participation), clinical coordination, and business operations . This individual will be responsible for overseeing the… more
- Cambridge Health Alliance (Cambridge, MA)
- Director , Health Plan Operations - PACE Elder...Lead government relations as they pertain to Health Plan Operations . * Manage all aspects of Medicare and ... supportive environment. **Position Overview** CHA PACE is seeking a strategic and detail-oriented ** Director of Health Plan Operations (HPO)** to lead and manage… more
- Molina Healthcare (Boise, ID)
- …The Operational/Regulatory Oversight Analyst works with health plans and operations departments to assess, oversee, and recommend business practices to ... Analyst develops and performs audits and oversight functions involving business-critical operations and vendor outsourcing arrangements for the company. The Analyst… more
Related Job Searches:
Director,
Director Operations,
Medicare,
Medicare Director,
Medicare Operations,
Operations