- Molina Healthcare (Orem, UT)
- …relative to Molina Medicare . The Director is co-chairman of the Molina Medicare Compliance Committee. The Director , working with the MHI VP ... Compliance , is accountable to the Molina Medicare Compliance Committee for all ...implementation and maintenance of the Molina Medicare Compliance Plan and audit activities. The Director … more
- Humana (Salt Lake City, UT)
- …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 ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Salt Lake City, UT)
- …our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The ... Corporate Medical Director works on problems of diverse scope and complexity...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents… more
- Molina Healthcare (Orem, UT)
- …or related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with ... **Job** ** ** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module...entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the… more
- Molina Healthcare (Orem, UT)
- …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
- Humana (Salt Lake City, UT)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Humana (Salt Lake City, UT)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Evolent (Salt Lake City, UT)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical leadership team, providing ... + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into the types of...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Salt Lake City, UT)
- …mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission… more
- Evolent (Salt Lake City, UT)
- …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology to ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission… more
- Humana (Salt Lake City, UT)
- …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 ... UT, WY, ID) **Clinical Strategy Execution & Provider Engagement** The Clinical Director will partner with provider leadership by: * Developing and maintaining strong… more
- Evolent (Salt Lake City, UT)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a key member of the utilization management team. We ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission… more
- Evolent (Salt Lake City, UT)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management team. We ... in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission… more
- Otsuka America Pharmaceutical Inc. (Salt Lake City, UT)
- Director , Field Reimbursement Management (FRM) Position Overview We are seeking an experienced, transformative leader to serve as the Director , Field ... Drive post-prescribing performance through strategic planning and execution + Ensure compliance adherence through in-field visits, call and case monitoring, aligning… more
- Evolent (Salt Lake City, UT)
- …the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in **Performance Suite ... + Offer **clinical rationale for standard and expedited appeals,** ensuring compliance with UM policies and regulatory requirements. + Collaborate with… more
- CenterWell (Salt Lake City, UT)
- …training program for coding staff to ensure continuous skill development and compliance with coding standards. + Partner with analytics and audit to identify ... to travel up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track record of working… more
- University of Utah (Salt Lake City, UT)
- Details **Open Date** 06/24/2025 **Requisition Number** PRN42278B **Job Title** Senior Compliance Officer **Working Title** Senior Compliance Specialist **Job ... Summary** **VP Area** President **Department** 01345 - HCI Clinical Resrch Compliance **Location** Campus **City** Salt Lake City, UT **Type of Recruitment**… more