- CVS Health (Hartford, CT)
- …Network Contracting and Medicaid Provider Relations, and other departments to maintain compliance of provider related tasks. The Lead Director may manage a ... part of the Aetna Network organization and have oversight and monitoring of Medicaid network compliance requirements, focused first on Medicaid credentialing… more
- Elevance Health (Indianapolis, IN)
- ** Medicaid Quality Management Health Plan Director Sr.** **Location:** This position will work a hybrid model (remote and office) out of the Indianapolis, ... to relocate or currently reside within 50 miles of the Indianapolis office. The ** Medicaid ** **Quality Management Health Plan Director Sr.** will be… more
- CVS Health (Hartford, CT)
- …convenient and affordable. Job Purpose and Summary: The LTSS/SAI National Senior Medical Director , reporting to a Regional CMO of Medicaid , will collaborate with ... Aetna National Medicaid , Regional and health plan leadership to identify, develop, implement, and evaluate the effectiveness of key LTSS strategic initiatives… more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director ... (10) Years of Clinical Practice with Older Adults (Medical Director ) is dedicated full time to the Indiana Pathways...authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which… more
- Humana (Columbus, OH)
- …community and help us put health first** The Behavioral Health Medical Director may develop procedures, processes, productivity targets, and new delivery models. ... components, and work is performed without direction. The Behavioral Health Medical Director actively uses their medical background, experience, and judgement to make… more
- CVS Health (Irving, TX)
- …care more personal, convenient and affordable. Position Summary The Lead Director , Network Management (Texas) is accountable for designing conceptual models, ... initiative planning, and negotiating Medicaid value based agreements with Texas providers, including health systems, clinically integrated networks, IPAs, FQHCs and… more
- CVS Health (Austin, TX)
- …. Health Plan /Payer or Provider Systems experience Preferred Qualifications . Medicaid regulatory experience . Medicaid contracting & setup experience. . ... health care more personal, convenient and affordable. Position Summary The Lead Director will manage the development of contracts and agreements with providers and… more
- Elevance Health (Columbia, SC)
- **Operations Director - Medicaid ** **Location:** Columbia, South Carolina. This position will work a hybrid model (remote and office). The ideal candidate will ... our South Carolina Elevance Health PulsePoint locations. The **Operations Director - Medicaid ** will be responsible for...internal departments and an effective liaison role with Health Plan support services. **How you will make an impact:**… more
- Humana (Frankfort, KY)
- …problems of diverse scope and complexity ranging from moderate to substantial. The Medicaid Pharmacy Director , internally known as a Clinical Pharmacy Lead, ... of Pharmacy and implements changes as necessary to maintain compliance supporting both the business and public relations strategies....per yearThis job is eligible for a bonus incentive plan . This incentive opportunity is based upon company and/or… more
- Conduent (Hamilton, NJ)
- …of a culture where individuality is noticed and valued every day. ** Director , Medicaid Eligibility** **_(Relocation Assistance & $ign-On Bonus available)_** **Do ... situations for all levels of employees and management. + Collaborating with compliance owners to ensure processes align with regulatory requirements for applicable… more
- Universal Health Services (Leesburg, VA)
- …documentation meet the requirements of the regulatory agencies mentioned above. + The Medicaid Specialist must report regularly to the Director of Risk ... a Partial Hospitalization Program, and a 40-bed acute psychiatric hospital. Our strategic plan for the past two years has been centered on improving fidelity to… more
- Humana (Richmond, VA)
- …implementations are involved + Be on point for the technology portion of all state Medicaid compliance audits. These will often tie back to the P&Ps noted here ... diverse scope and complexity ranging from moderate to substantial. The Medicaid Lead, Technology Solutions builds strategic partnerships and manages relationships… more
- Highmark Health (Charleston, WV)
- …Awareness Series (HAS). + Educate and assist members with various elements of Medicaid entitlements, benefit plan information and available services created to ... MHT Member Advocate must collaborate with the Care Management Director and care coordinators, provide member support related to...plan interacts. + Review and recommend all health plan informational materials to be distributed to Medicaid… more
- CVS Health (New York, NY)
- …Relations representatives (approximately 4) and reports to the local Lead Director . Oversees the maintenance of working relationships with the existing network ... and delivery systems in conjunction with network. Engages to ensure compliance and regulatory requirements are met. Develops and implements training programs… more
- Bausch Health (Bridgewater, NJ)
- …for leading compliance in regulated government/federal programs and price calculations ( Medicaid AMPs, BPs, Medicare Part B ASPs, PHS 340B pricing & Non-FAMPs). ... + Oversight of all government program related activities (ie, TX state Medicaid formulary additions, PHS 340B non- compliance disclosure letters, etc.).… more
- Bozeman Health (Bozeman, MT)
- …the managerial and administrative tasks involved in establishing, monitoring and updating the Compliance Plan as well as the Compliance Department's ... Bozeman Health Board of Directors has designated the System Director of Compliance & Privacy to serve...Functions: + Establishes, monitors, and updates the Bozeman Health Compliance Plan . + Maintains compliance … more
- Trinity Health (Ann Arbor, MI)
- …medical groups owned by Trinity Health and Trinity Health Corporate. The Research Compliance Director will be responsible for overseeing a comprehensive Research ... program for adherence to the Centers for Medicare & Medicaid Services (CMS) regulations for billing of research. The...skills are critical to the role. + The Research Compliance Director must be credible and effective… more
- Option Care Health (Columbus, OH)
- …developing, and retaining a diverse workforce. **Job Description Summary:** The Director , Compliance Investigations is responsible for developing and maintaining ... the Company's compliance program, including but not limited to the Annual Compliance & Privacy Work Plan , including assessing the effectiveness of Company's … more
- HCA Healthcare (Riverside, CA)
- …is hired below midpoint of the range. **Introduction** We are seeking a(an) Director of Regulatory Compliance with Riverside Community Hospital to promote growth ... resources for emotional, physical and financial wellbeing + 401(k) Plan with a 100% match on 3% to 9%...benefits may vary by location._** We are seeking a(an) Director of Regulatory Compliance for our team… more
- Teva Pharmaceuticals (Parsippany, NJ)
- …opportunity** The Director , Government Pricing is responsible for the company's compliance with both the Medicaid Drug Rebate Program's and Federal Agency's ... customer contracts and related financial processes that directly impact government pricing and compliance . The Director , GP is expected to be a subject matter… more