- Option Care Health (Bannockburn, IL)
- …hiring, developing, and retaining a diverse workforce. Job Description Summary:The Director , Compliance Investigations is responsible for developing and ... and abuse, including but not limited to HIPAA, Anti-Kickback, Stark, Medicare /Medicaid reimbursement. Experience evaluating information to determine compliance … more
- Atrium Health (Charlotte, NC)
- …knowledge and understanding of national coding guidelines and standards of compliance to improve overall quality and completeness of clinical documentation within ... quality of care metrics. Assumes accountability as delegated by the Director . Essential Functions: Position manages and develops interprofessional teams, providing… more
- Commonwealth Care Alliance (Boston, MA)
- … Compliance works directly with the Vice President Health Plan Regulatory Compliance /National Medicare Compliance Officer to develop and maintain an ... Overall Compliance Infrastructure** + Work collaboratively with the VP Medicare Compliance on strategic department planning including budget development,… more
- The Cigna Group (Bloomfield, CT)
- …provide significant opportunities for a leader to shape a significant component of the Medicare Growth strategy. The Director of Telesales will lead strategy and ... **Work Location: Remote - United States** **Summary** The Direct to Consumer (DTC) Medicare channel is a significant driver of current and future growth and… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** Under direction of the Director of Medicare Compliance , the primary focus areas of this position include development ... + 5 or more years direct work experience in regulatory affairs and/or compliance in Medicare or Medicaid required + 5 or more years of managerial experience… more
- CVS Health (Hartford, CT)
- … based (work at home) based anywhere in the US.**Responsibilities of this Medical Director role are related to Medicare Appeals.* Direct daily work on part ... monitoring and tracking and Utilization Management Strategy support* Collaborative work with Medicare Quality and Compliance on an ongoing basis* Develop subject… more
- Humana (Columbus, OH)
- …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
- Option Care Health (Columbus, OH)
- …developing, and retaining a diverse workforce. **Job Description Summary:** The Director , Compliance Investigations is responsible for developing and maintaining ... and abuse, including but not limited to HIPAA, Anti-Kickback, Stark, Medicare /Medicaid reimbursement. Experience evaluating information to determine compliance … more
- The Cigna Group (Birmingham, AL)
- **_LOCATION: Hybrid/ Remote position aligned to the Tri-South Alabama/Mississippi Market. Must live in either Alabama or Mississippi._** The **Manager, Provider ... member of the Provider Contracting Team and reports to the Provider Contracting Director . This role assists in developing the strategic direction and management of… more
- Martin's Point Health Care (Portland, ME)
- …of Medicare Risk Adjustment initiatives and operations. The Senior Director is also responsible for all aspects of the decision-making and implementation ... Place to Work" since 2015. Position Summary The Senior Director of Risk Adjustment Operations in our Health Plan...Complies with Risk Adjustment regulatory rules. + Partners with compliance and finance to ensure compliance with… more
- Carle (Urbana, IL)
- Director of Reimbursement - Remote + Department: Accounting - CFH + Entity: Champaign-Urbana Service Area + Job Category: Professional + Employment Type: Full - ... Education Required: Bachelors Degree + Shift: Day + Location: Remote + Usual Schedule: M-F: 8A - 5P +...the annual operating budget. + Directs and coordinates the Medicare and Medicaid cost reports and related compliance… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director of Utilization Management leads and manages all utilization management (UM) functions for physical health services ... and supports to ensure achievement of business results while maintaining compliance with all contract requirements, state and federal regulatory requirements and… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** **Position Summary:** The Director , Quality & Control Assurance reports to the VP of Quality & Control Assurance is responsible ... leadership and oversight for the Quality & Control Assurance within CCA's Compliance department. This position designs, continually matures, promotes, & develops a… more
- Banner Health (AZ)
- …We are proud to offer our team members many career and lifestyle choices including remote & hybrid work options. Apply today. Banner Plans & Networks (BPN) is an ... integrated network for Medicare and private health plans. Known nationally as an...your experience and skills to BPN. As an Associate Director Registered Nurse RN Care Management, you will call… more
- NASCO (Columbus, OH)
- **Overview** Under general direction, the Executive Director , Compliance will lead and provide oversight and management of Compliance and Privacy functions ... and serve as the company's Compliance and Privacy Official. Responsible for overseeing the company's... Office. This role will have oversight responsibility for Medicare Advantage and ACA Exchanges strategy and executive relationship… more
- Elevance Health (Atlanta, GA)
- …Federal Regulatory Compliance ; Commercial and Specialty, Medicaid and Medicare Compliance ; Finance; Procurement; Corporate Governance; and Human Resources. ... ** Director II Compliance ** **Location:** This position will work a hybrid model ( remote and office). The Ideal candidate will live within 50 miles of one of… more
- Elevance Health (Woodland Hills, CA)
- …and managing business associate agreements. + Experience supporting Commercial, Medicaid and Medicare compliance programs. + Travels to worksite and other ... ** Director I Compliance - Privacy** **Location:** This position will work a hybrid model ( remote and office). The ideal candidate will live within 50 miles… more
- Molina Healthcare (Long Beach, CA)
- …to meet critical needs. + Escalates gaps and barriers in implementation and compliance to AVP, VP and senior management. + Consultative role, develops business case ... Experience** 10+ years Knowledge of Government programs. Medicaid & Medicare experience. Provider Reimbursement Configuration Project Management experience. To all… more
- University of Rochester (Rochester, NY)
- Responsibilities **Position Summary:** **This position oversees outpatient Medicare , Medicaid and third-party payor audits, and directs all responses to assure ... outpatient billing areas in relation to audits through interaction with the Director , Managers and Supervisors within the Patient Financial Services office to assure… more
- Humana (Columbus, OH)
- …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
