- Molina Healthcare (Cincinnati, 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
- Humana (Columbus, OH)
- …efforts that enhance both provider and patient experience. **Governance & Delegation Oversight ** The Clinical Director will participate in governance committees ... part of our caring community and help us put health first** The Clinical Director is a key member of the regional clinical leadership team responsible for executing… more
- CenterWell (Columbus, OH)
- …and communicate remediation plan to IPA Dyad partners. + Partners with market operational leaders to identify operational issues that impact clinician and coder ... staff workload and redistribute resources as needed to meet market operational demands. + Monitor coding processes, identify inefficiency, and develop… more
- Elevance Health (Columbus, OH)
- ** Director II Provider Economics - Value-Based Specialty Care** **Location:** This role requires associates to be in-office 3 days per week, fostering collaboration ... a dynamic and adaptable workplace. Alternate locations may be considered. The ** Director II, Provider Economics** , will lead strategic analytics and payment design… more
- CenterWell (Columbus, OH)
- …Director , the Senior Strategy Advancement Professional will bring a combination of operational support, analyst skills, and strategy oversight to the role. ... (ACO) business. This role will be responsible for supporting the CenterWell ACO and Medicare payment model programs via the Center for Medicare and Medicaid… more
- 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
- Molina Healthcare (Dayton, OH)
- …in collaboration with the Manager or Director . * Keeps Manager or Director apprised of operational issues, including staffing resources, program and system ... drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics with regard to patient… more