- Molina Healthcare (Houston, TX)
- …relative to Molina Medicare . The Director is co-chairman of the Molina Medicare Compliance Committee. The Director , working with the MHI VP ... Compliance , is accountable to the Molina Medicare Compliance Committee for all ...implementation and maintenance of the Molina Medicare Compliance Plan and audit activities. The Director … more
- Molina Healthcare (Houston, TX)
- …or related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with ... **Job** ** ** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module...entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the… more
- Molina Healthcare (Houston, TX)
- …of the 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
- Molina Healthcare (Houston, TX)
- …of Coverage for print and online distribution via the iCat authoring process, ensuring compliance with CMS guidelines. Support Medicare and MMP line of business ... completion including adhoc projects and submissions as assigned by the Director of Medicare Programs. **KNOWLEDGE/SKILLS/ABILITIES** + Initiate projects by… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Director Governmental Reporting is responsible for ensuring that Houston Methodist meets all internal and external financial and ... governmental reporting requirements. Requirements include Medicare cost reports, Federal Tax Returns Health and Human Services (HHS)/Centers for Medicare and… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Director Managed Care Contracting position is responsible for the development, negotiation, maintenance and payer relations of the Houston ... managed care payers include commercial payers, separate transplant contracts, Medicare Advantage, Medicaid Health Maintenance Organizations (HMOs), International, behavioral… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Director Case Mgmt Social Svcs position is responsible for strategy, function and operations of the Case Management & Social Work ... promoting the most cost-effective utilization of the hospital's resources. The Director Case Mgmt Social Svcs position deploys population-focused teams to enhance… more
- Gentiva (Pasadena, TX)
- **Overview** We're looking for a ** Director of Palliative Care - RN** to join our team. You will report directly to the VP of Palliative Care. You will be ... Establish and maintain standards of high quality care and customer service in compliance with federal and state regulations and guidelines + May provide skilled… more
- Gentiva (Pasadena, TX)
- **Overview** We're looking for a ** Director of Palliative Care - Nurse Practitioner** to join our team. You will report directly to the VP of Palliative Care. You ... follow up under the direction of the Palliative Medical Director (if required under State law). + Establish, implement,...standards of high quality care and customer service in compliance with federal and state regulations and guidelines **About… more
- Molina Healthcare (Houston, TX)
- …Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Plans, organizes, ... and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct management and… more
- Molina Healthcare (Houston, TX)
- …Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations ... between Molina Healthcare and contracted provider network. In partnership with Director , manages and coordinates the Provider Services activities for the state… more
- Molina Healthcare (Houston, TX)
- …and appropriate outreach and coordination of services, including MTM services for Medicare and Medicaid eligible members as well as Medication Adherence Programs for ... to ensure prompt resolution of identified issues. * Ensures compliance with all CMS guidelines and reporting requirements for...to drug therapy were implemented. * Assists Manager or Director in the collection and tabulation of data for… more
- Molina Healthcare (Houston, TX)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality ... opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may require remediation...skills. **PREFERRED QUALIFICATIONS:** + 1 year of experience in Medicare and in Medicaid managed care + Experience with… more
- Molina Healthcare (Houston, TX)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid) Executes health plan's member and community quality ... opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may require remediation...or Healthcare Administration + 1 year of experience in Medicare and in Medicaid managed care + Certified Professional… more