- CVS Health (New Albany, OH)
- …is compliantly and effectively operating in the market. As such, the Lead Director of Medicare Operations supports MAPD and SNP initiatives and ... of the Chief Medicare Officer, may facilitate internal and external Medicare audit activity including CMS and operations integrity audits. Coordinates file… more
- Molina Healthcare (OH)
- …local regulatory requirements. **Job Duties** + Under the leadership of the VP Medicare Segment Lead , this role will facilitate transparent and compliant ... + 5-10 years' experience in Managed Care, specifically government programs and/or Medicare /Duals Health Plan Operations + Strong leadership in a matrixed… more
- Elevance Health (Cincinnati, OH)
- ** Medicare Medical Director ** Location: This position will work a hybrid model (remote and office). The ideal candidate will must live within 50 miles of one of ... be able to work Eastern Time Zone hours. The ** Medicare Medical Director ** is responsible for the...consultation and serve as clinical/strategic advisor to enhance clinical operations . May identify cost of care opportunities. May serve… more
- Evolent (Columbus, OH)
- …You'll Be Doing:** **What You'll Be Doing:** Evolent is looking for a Managing Director of Value-Based Operations to join our Primary Care Leadership Team. This ... Medicare in the Shared Savings Program. The Managing Director will report to the SVP Primary Care /...operational teams for each reporting in. The MD will lead our Quality program, with accountability for ECP's Quality… more
- Molina Healthcare (OH)
- …operational process designs, setting procedural standards, and overseeing vendor operations to ensure compliance with key performance indicators (KPIs) and ... Pre- and Post-pay COB, Subrogation, Premium Enhancement (such as ESRD and Medicare Secondary Payer) and Pre-pay Editing for correct coding and medical payment… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Associate Director , Actuarial provides actuarial support across a broad range of actuarial and business ... needs for specific product lines. The Associate Director , Actuarial requires a solid understanding of how organization.... Analytics . Forecasting . Risk . Compliance . Operations Decisions are typically related to identifying and resolving… more
- Mathematica (Columbus, OH)
- …will have a deep understanding of systems and logical-technical approaches to lead winning analytics and technology-related proposal efforts. * Responsibilities:* * ... Lead and manage the full lifecycle of proposal development,...Mathematica's contractual and regulatory requirements. * Act as Project Director on select awarded projects, ensuring successful execution from… more
- Evolent (Columbus, OH)
- …directly to the Chief Medical Officer. The CCO will lead the Clinical Operations team and work with medical director leadership to ensure consistent and ... be responsible for leadership, professional development, and performance of the clinical operations team. Within the Clinical Services team, the CCO will also have… more
- Prime Therapeutics (Columbus, OH)
- …organization to validate regulatory reporting requirements are met and that business operations are aligned with expectations of applicable regulatory guidance + ... Lead project management efforts for highly sensitive Compliance initiatives...organization, or other highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +… more
- Molina Healthcare (OH)
- …leading this program and be accountable for its success, reporting to the Director of Clinical Value. **KNOWLEDGE/SKILLS/ABILITIES** + Lead teams in identifying, ... **JOB DESCRIPTION** **Job Summary** Working closely with Molina enterprise Clinical Operations and Health Plan healthcare services leaders, and Medical Economics and… more
- Trinity Health (Grove City, OH)
- …, a college of nursing (https://www.mccn.edu) , a Medicare Advantage plan (https://www.medigold.com) , and extensive outreach and ... hospital and center staff members to facilitate the daily operations of the sterile processing area of the Surgical...issues, or needs as they arise to the Administrative Director of Perioperative Services. + Provides performance feedback and… more