- Molina Healthcare (Buffalo, NY)
- …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 (Buffalo, NY)
- …by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the standards and controls that ... for CMS audits and data-validation reviews * Ability to quantify financial, regulatory , and member-experience risk from complaint trends and to drive prioritized… more
- Molina Healthcare (Buffalo, NY)
- …Medical License without restrictions (free of sanctions from Medicaid or Medicare ) **PREFERRED EDUCATION:** Master's in Business Administration , Public Health, ... **Job Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of… more
- Molina Healthcare (Buffalo, NY)
- …medical director , and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality ... without restrictions to practice and free of sanctions from Medicaid or Medicare . **PREFERRED EDUCATION:** Master's in Business Administration , Public Health,… more
- Fallon Health (Buffalo, NY)
- … administration or related field + A minimum of 2 years of regulatory compliance experience required + Understanding of Medicare and Medicaid regulations a ... **Brief summary of purpose:** Assists the FHW PACE Program Director to oversee and manage PACE program level operational...to oversee and manage PACE program level operational and regulatory functions in support of the program's quality, strategic… 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 ... the Quality Management/Utilization Management (QM/UM) Plan, including having the BH Medical Director for Children's Services and participate on the BH committees for… more