- Molina Healthcare (Buffalo, NY)
- …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
- Molina Healthcare (Buffalo, NY)
- …to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight , monitoring ... and implements process improvements to achieve member/provider satisfaction or operational effectiveness/efficiencies which contribute to Molina Medicare 's… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …implementation of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has overall accountability for BH services ... interdisciplinary complex care management rounds. + Provision of clinical oversight and leadership to Utilization Management/Case Management (UM/CM) staff working… more
- Fallon Health (Buffalo, NY)
- …PACE Program Director to oversee and manage PACE program level operational and regulatory functions in support of the program's quality, strategic and financial ... to local contracted partners to provide support/guidance on various operational topics. $95,000 **Responsibilities** **Primary Job Responsibilities:** **Data management,… more
- Molina Healthcare (Buffalo, NY)
- …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
- Molina Healthcare (Buffalo, NY)
- …strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core ... contracts. Issue escalations, network adequacy, Joint Operating Committees, and delegation oversight . Tighter knit proximity ongoing after contract. * In conjunction… more