- Humana (Columbus, OH)
- …or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical interpretation ... of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests for services. The… more
- AmeriHealth Caritas (Newtown Square, PA)
- **Corporate Director , Population Health Clinical Operations, Medicare ** Location: Newtown Square, PA Primary Job Function: Medical Management ID**: 37990 **Job ... Medicare Care Management and the Chief Medical Officer, the Corporate Director , Population Health Medicare Clinical Operations is responsible for multiple… more
- Molina Healthcare (NY)
- …Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulatory requirements. **Job ... Duties** + Under the leadership of the VP Medicare Segment Lead, this role will facilitate transparent and...between segment, health plans, and shared services to drive compliance and performance objectives as well as provide oversight,… more
- Healthfirst (NY)
- **Duties & Responsibilities:** + Develops, refines, and executes Medicare telesales strategy, including partnership with Dial America and across the various sales ... with supporting areas (eg, Analytics, Development, etc.) and stakeholders within the Medicare Sales team to define and implement enhancements to tele sales… 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
- Elevance Health (Atlanta, GA)
- …Plan, design, develop and lead activities to ensure an effective Compliance program. + Oversees programs for multiple departments/functions with numerous ... objectives. + Collaborates with management to set strategic vision; oversees manager(s)/ director (s) with direct reports. + Hires, trains, coaches, counsels, and… 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
- Point32Health (Canton, MA)
- …are approved by senior leadership, the Senior Manager, in collaboration with the Director , is responsible for all necessary product filings with CMS and other ... business performance needs of each market. All responsibilities extend to any new Medicare markets should Point32Health choose to expand its footprint in the future.… more
- AmeriHealth Caritas (Newtown Square, PA)
- …services. Discover more about us at www.amerihealthcaritas.com . The Director of Compliance serves as the primary contact for Medicare and Medicaid ... compliance for **PerformRx** . The incumbent ensures overall compliance with all Medicare and Medicaid ...and those required by federal and state law. The Director of Compliance reports to the AmeriHealth… more
- BrightSpring Health Services (Arlington, TX)
- …Achieves productivity goals with regard to calls/claims per hour as determined by the Director and Clinical Hub Manager + Provide clinical support to members of the ... Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and State Laws, and applicable professional… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Associate Director , Compliance ensures compliance with governmental requirements. The Associate ... Director , Compliance requires a solid understanding of how organization capabilities...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Texas A&M University - Faculty (Dallas, TX)
- Academic Professional Track (Non-Tenure): Open Rank Clinical & Director of Clinical Compliance College of Dentistry Location Dallas, TX Open Date 11/13/2024 ... Professor. This position will include an administrative appointment as Director of Clinical Compliance and t he...eClinicalWorks, etc.) . Knowledge of managing patient care, HIPPA compliance , and centers for Medicare and Medicaid… 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)
- …to ensure compliance . * Works closely with the Governance, Risk & Compliance (GRC) teams ( Medicare , Medicaid, Privacy, Fraud, Waste & Abuse) for ... oversight, vendor management, health insurance government products and programs ( Medicare , Duals/SNP, Medicaid, LTSS), and/or compliance experience required,… more
- Baylor Scott & White Health (Dallas, TX)
- JOB SUMMARY Director Billing, Regulatory, and Provider Coding Compliance is responsible for planning, developing, and enforcing compliance programs for ... Baylor Scott and White Health (BSWH), which may include varied compliance functions and programs such as provider regulatory compliance , coding compliance , … more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing ... the Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify medical management operational improvements, including those… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Center (ETC) and its programs remain compliant with Centers for Medicare and Medicaid Services (CMS), Organ Procurement and Transplantation Network (OPTN)/United ... to monitor metrics and audit reports to ensure data integrity, policy compliance , and patient safety reporting both internally and externally, to appropriate… 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
- 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 ... level. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which...conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will… more
- CVS Health (Sacramento, CA)
- …(eg, specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance , Legal, Accreditation) and clients. The Medical Director ... Director UM decisions. If specifically assigned to one business segment (ie, Medicare clients), each director will become sufficiently skilled in various UM… more
Related Job Searches:
Associate Director Compliance Medicare,
Compliance,
Compliance Director,
Director,
Medicare,
Medicare Compliance,
Medicare Director