- Daiichi Sankyo, Inc. (Boston, MA)
- …areas centered around rare diseases and immune disorders. Summary: The Associate Director Field Reimbursement (ADFR) is a critical front-line member of the DSI ... the appropriate utilization of NCCN/ASCO guidelines, private payer, GPOs, Medicare and Medicaid structure, Specialty Pharmacy systems and reimbursement processes… more
- Daiichi Sankyo, Inc. (Seattle, WA)
- …areas centered around rare diseases and immune disorders. Summary: The Associate Director , Field Reimbursement (ADFR) is a critical front-line member of the DSI ... the appropriate utilization of NCCN/ASCO guidelines, private payer, GPOs, Medicare and Medicaid structure, Specialty Pharmacy systems and reimbursement processes… more
- Merck & Co. (North Wales, PA)
- Job DescriptionThe Director , US Market Access Contracting sits within the National Contract Operations and Supply Chain Team (NCOSC), which delivers best-in-class, ... and Infusion companies for our Company's commercial and government business.-The Director , US Market Access Contracting reports to the Executive Director… more
- UCLA Health (Los Angeles, CA)
- Description As the Assistant Director of Medicare Advantage Audit and Fraud Compliance , you'll play a crucial role in safeguarding our health plan resources ... compliance , Fraud, Waste, and Abuse (FWA) within our Medicare Advantage and Prescription Drug programs. Leading a team...field, required + Eight or more years of relevant compliance experience in a Medicare Managed Care… more
- Humana (Columbus, OH)
- …community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. The Behavioral ... Health Medical Director work assignments involve moderately complex to complex issues...authorized. All work occurs within a context of regulatory compliance and work is assisted by diverse resources which… 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 ... authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources, which...and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will… more
- Somatus (Mclean, VA)
- …and mental well-being + Community engagement opportunities + And more! The Sr. Director , Medicare Risk Adjustment (MRA) will lead the execution strategy and ... to optimize the programs' clinical benefit, financial accuracy and ensure program compliance with governing bodies' regulations, including the Center for Medicare… more
- CVS Health (Harrisburg, PA)
- …implementation and milestone tracking for business plans as Part of the Medicare benefit and product cycle. Directs the strategic development and implementation of ... large product initiatives, including new products and product enhancements for Medicare formularies, UM and clinical tools for Medicare PDP, MAPD and employer… more
- The Cigna Group (Plano, TX)
- …TEXAS market - can live in Houston, San Antonio, Dallas or Plano** The ** Director , Provider Contracting - Medicare ** serves as an integral member of the ... for service and sophisticated value-based reimbursements with providers for Cigna's Medicare product lines (eg, Hospital systems, Ancillaries, and large physician… more
- Travelers Insurance Company (Columbus, OH)
- …strategies for addressing and resolving various types of debt, including Medicare , to deliver positive financial outcomes. This role requires leveraging economic ... including lien analysis and Conditional Payments. This leader also supervises compliance and reporting duties as a Registered Reporting Entity for Travelers… more
- Healthfirst (NY)
- + Direct all prospect and sales activities for Medicare products for a specified geographic area. + Develop and Implementing strategies and policies relating to ... Medicare sales and service. + Ensure interpersonal effectiveness among...resolve any outstanding issues. + Ensure sales staff maintains compliance with all CMS /corporate policies and regulations. Work… more
- Centers Plan for Healthy Living (Staten Island, NY)
- … Medicare or Sales experience SCOPE INFORMATION # Direct Reports: Director of Medicare Marketing Physical Requirements: The physical requirements described ... Medicare MAP Advisor 75 Vanderbilt Ave, Staten Island,...additional marketing locations while adhering to company regulatory guidelines. Compliance + Requires continues education to stay abreast on… more
- The Cigna Group (Bloomfield, CT)
- …a critical position on the NANPM Team and a direct report to the Senior Director of NANPM Medicare & Commercial Alignment. Experience with Medicare Advantage ... This is a ** Medicare Advantage position** WORK LOCATION: REMOTE position The...strategic level engaging **directly with Senior Leadership from Legal, Compliance , Network, Product, Clinical and Strategic Sourcing; and is**… more
- The Cigna Group (Nashville, TN)
- …of the National Development and Network Solutions team, reporting directly to the Medicare National Partnerships Director . This role is a key contributor for ... **What You'll Do** The Medicare National Contracting Advisor position is an integral...value-based and risk contracts through matrix partners. + Ensures compliance with contracting and compliance guidelines. +… more
- The Cigna Group (St. Louis, MO)
- …Operations Senior Advisor will report to the Stars and Risk Adjustment Managing Director and will be responsible for internal and external team communications and ... lines of businesses, stakeholders, and matrix partners (ex. Clinical, Compliance , Operations, Growth, Finance, etc.), providing proactive identification of… more
- The Cigna Group (Nashville, TN)
- …Senior Manager will work with the Provider Data Quality & Accuracy (PDQA) Director to establish the framework and policies to drive improvements in the provider ... Functions and Responsibilities** + Coordinate and partner with the key Medicare operations teams, including claims, enrollment, fulfillment, network operations, and… more
- The Cigna Group (Maitland, FL)
- …and Network Development & Solutions). Reporting to the Provider Performance Director , the Provider Performance Manager ensures the effective management of the ... action plans, reviews/evaluations and any accompanying analysis. + Driving excellence in compliance , consistency in approach to being the partner of choice for… more
- The Cigna Group (Atlanta, GA)
- …& Solutions). Reporting to the Network Operations Senior Manager or Director , this individual ensures the effective performance management of the provider ... leader for the local market. + Responsible for maintaining compliance to CMS and company policies and guidelines. +...members contribute to the growth and profitability of the Medicare Advantage business in their market in the following… more
- Brockton Hospital (Brockton, MA)
- …resources to make a difference in the lives and health of our patients. The Assistant Director , Corporate Compliance (Assistant Director ) is a member of the ... for assisting the Chief Compliance Officer (CCO) with the institutional compliance program planning and execution. The Assistant Director will utilize prior… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Senior Director , Third Party Compliance Oversight reports directly to the SVP, Corporate Compliance & Ethics and ... compliance . + Works closely with the Governance, Risk & Compliance (GRC) teams ( Medicare , Medicaid, Privacy, Fraud, Waste & Abuse) for dissemination of new… more
