- CCS (Clearwater, FL)
- …attendance and is flexible to meet the needs of the Follows all Medicare , Medicaid, HIPAA, and Private Insurance regulations and Abides by all regulations, policies, ... ones and channel this into a relentless pursuit of customer satisfaction in every part of our business. Ensure that the patient is the driving force behind business… more
- CenCal Health (Santa Barbara, CA)
- …as those related to NCQA certification and implementation of the Medicare D -SNP line of business Qualifications Knowledge/Skills/Abilities Required: In-depth ... Reporting to the Chief Medical Officer, or his/her designee, the Medical Director is responsible for providing clinical oversight for utilization, quality, care… more
- TrustBridge, Inc. (Fort Lauderdale, FL)
- …Spending Account Generous PTO package Responsibilities JOB SUMMARY The Associate Medical Director is a TrustBridge, Inc. employee responsible for the direction of ... in cooperation with the patient's attending physician. The Associate Medical Director is responsible for determining prognosis and eligibility for hospice services,… more
- Option Care Enterprises, Inc. (Baton Rouge, LA)
- …Basic understanding of billing and reimbursement procedures for hospital, medical offices, and Medicare (B/ D benefits) as well as medical offices. One year ... As a two-year recipient of the Gallup Exceptional Workplace Award, we recognize that part of being extraordinary is building a thriving workforce that is as unique… more
- University of Southern California (Arcadia, CA)
- …maintaining compliance with the Joint Commission (TJC) and Center for Medicare /Medicaid standards and conditions of participation. Having oversight for clinical ... work environment. ESSENTIAL JOB FUNCTIONS AND CORE RESPONSIBILITIES Accountable to Executive Director of Emergency Services for overall work performance. Acts as a… more
- University of Southern California (Arcadia, CA)
- …for specific performance and/or outcome indicators as determined by the director . Communicates with Financial Counselor to facilitate covered day reimbursement ... continuous improvement in both areas. Perform 100% UR Review on all Medicare One-Day admissions. Proactively identifies and resolves delays and obstacles to… more
- UHS (Temecula, CA)
- Responsibilities About Temecula Valley Hospital Temecula Valley Hospital (TVH), part of Southwest Healthcare, brings advanced technology, innovative programs, ... to achieve certification as a Gluten-Free Food Service facility, 3 Star Medicare Hospital Compare Rating, the American College of Cardiology Chest Pain Center… more
- DHR Health (Edinburg, TX)
- …concerning fee increases. Reimbursement - Periodically reviews the reimbursement of Medicare , Medicaid, HMO and PPO payers and commercial carriers and informs ... in the area. Other information: LINES OF REPSONSIBILITIES: (Chain-of-command) Director of DHR Health Clinics2. Chief Ambulatory Officer CUSTOMER...who performs these duties are not called upon as part of their employment to perform or assist in… more
- CVS Health (Boston, MA)
- …Key Responsibilities: + Lead the development and execution of actuarial analytics strategies for Medicare Advantage and Part D programs. + Inform and enhance ... and pricing. The ideal candidate will have deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies.… more
- Bristol Myers Squibb (Princeton, NJ)
- …reporting and analysis. **Responsibilities:** + Consolidate and maintain GTN projections for Commercial, Medicare Part D , and GPO contracted accounts + ... personal lives. Read more: careers.bms.com/working-with-us . **Summary:** The Commercial & Medicare Channel Lead will manage forecasting and analytics for the… more
- Centene Corporation (Queens, NY)
- …performance oversight for Medicare Advantage and Dual Eligible Special Needs Plans ( D -SNPs). The Manager will serve as a subject matter expert in Medicare ... position will be responsible for working with the VBP Director , other VBP Managers, and Analysts, as well as...strategic advisor on contract structure and payment methodologies for Medicare Advantage and D -SNP providers, supporting new… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …product development, operations, financing and revenue generating programs + Knowledge of Medicare Part D program, operations and industry trends ... The Medicare Risk Adjustment Strategy Program Manager will report to the Senior Director of Medicare Risk Adjustment and Analytics. This role will manage the… more
- Central Maine Medical Center (Lewiston, ME)
- …and for each other every day. Position Summary: Reporting to the Nursing Director , the Nurse Leader is responsible for the day-to-day operations of assigned ... evaluating the operation of their assigned department. In conjunction with the Director , the Nurse Leader is responsible for overseeing implementation of patient… more
- Molina Healthcare (Boise, ID)
- …and internal policies and procedures. * Supports the Operational Oversight Manager, Director , and team in the general development of the Operational Oversight ... to demonstrate compliance to regulatory requirements. * Supports Manager and Director with developing the Operational Oversight Work Plan, monitoring and reporting… more
- Cambridge Health Alliance (Cambridge, MA)
- …PACE and HPO. * Lead internal and external audit preparation and response, including Medicare Part D and Enrollment Data Verification. * Develop and ... Director , Health Plan Operations - PACE Elder Service...participants. This role is responsible for overseeing Medicaid and Medicare enrollment, claims, reporting, risk adjustment, compliance, contract management,… more
- Amneal Pharmaceuticals (Bridgewater, NJ)
- …to our current Market Access landscape (ie IRA and its impact on Amneal products for Medicare Part D ). Manage to a market access budget throughout the year, ... Description: The Senior Director of Market Access Strategy is responsible for...Pharmacy benefit formularies, across all lines of business (Commercial, Medicare , & Managed Medicaid), as well as monitoring and… more
- Trinity Health (Gaithersburg, MD)
- …of Directors. + Ensure compliance with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance Program. Assure ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Director , Quality, Improvement and Compliance** **Location:** Trinity Health PACE of… more
- The Cigna Group (St. Louis, MO)
- …of Regulated Markets is responsible for Coverage Review and Determinations for Medicare Part B and Part D , Medicaid, Marketplace or Healthcare Reform ... **Job Description: Director for Regulated Markets - CDAG/ODAG** **Excited to...of technical requirements to ensure ongoing compliance, Center for Medicare and Medicaid (CMS) Audit support and end-to-end ownership… more
- WelbeHealth (Los Angeles, CA)
- …financial modeling tools + Deep understanding of CMS risk adjustment, Medicaid rate-setting, and Medicare Advantage/ Part D payment models + Must be willing ... seniors with better quality and compassion in a value-based model. The Director , Actuary is accountable for all actuarial functions related to PACE revenue,… more
- Bristol Myers Squibb (Washington, DC)
- …role will lead our efforts in existing and future expected negotiations for products that span Medicare Parts D and B. The role will also be a key SME advisor ... lives. Read more: careers.bms.com/working-with-us . **Summary:** We are currently seeking a Director , IRA Project Management to join the US Pricing, Analytics and… more
