- 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
- 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 ... representing over 40% of Cigna's total medical cost savings. The **NANPM Medicare Senior Advisor** is responsible for negotiating Medicare Supplemental… more
- Corewell Health (Grand Rapids, MI)
- …Ensure compliance to CMS requirements and standards + Other projects assigned by Medicare Quality Manager and/or Director How Corewell Health cares for you + ... Job Summary The Medicare Quality Specialist, Pharmacy will assist the ...numbers, and performing data analysis to ensure accuracy and compliance + Assist members in understanding and navigating their… more
- Providence (Beaverton, OR)
- …them._** **Providence Health Plan is calling an** HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA **who will:** + Perform internal coding audits of ... Risk Adjustment staff, contractors, and vendors + Perform audits to ensure compliance with national coding guidelines and industry regulations, as well as adherence… 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
- 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
- University of Michigan (Ann Arbor, MI)
- Senior Corporate Compliance Director - HIPAA Officer Apply Now **Job Summary** The Senior Corporate Compliance Director (?Senior Director ?) is ... States Department of Justice (DOJ) and the Centers for Medicare and Medicaid Services (CMS). This position will provide...Detail** **Job Opening ID** 256136 **Working Title** Senior Corporate Compliance Director - HIPAA Officer **Job Title**… 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
- 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
- Centene Corporation (Austin, TX)
- …Purpose:** Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Individual Coverage Health ... Arrangement (ICHRA), Mental Health Parity and Addiction Equity Act (MHPAEA), and Medicare Supplement line of business, which includes implementation of elements of… 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)
- …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 (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
- 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 ... meet authorization requirements. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- MetroLink (Los Angeles, CA)
- Assistant Director , Finance (Grants) Print (https://www.governmentjobs.com/careers/scrra/jobs/newprint/4648818) Apply Assistant Director , Finance (Grants) ... Questions SUMMARY PURPOSE OF POSITION Metrolink is seeking a highly skilled Assistant Director , Finance to join our Finance team. The Assistant Director , Finance… more
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