- Unknown (Albuquerque, NM)
- …a deep understanding of compliance requirements, particularly in the areas of Medicare and Medicaid, are essential. The Executive Director will also be ... Executive Director , Nonprofit Operations & Family Services About the...The Company is in search of a dedicated Executive Director to lead its mission of providing comfort, care,… more
- Gentiva (Stevens Point, WI)
- …Titles Hospice RN leadership, Director of Clinical Services jobs, Hospice nurse director , Hospice compliance RN, and Medicare Hospice regulations ReqID: ... Care. Transform Hospice Services.** We are seeking a RN Director of Clinical Services to join our team. Reporting...responsible for ensuring the appropriate delivery of hospice services, compliance with Medicare Hospice Benefit Conditions of… more
- Elevance Health (Tampa, FL)
- **Medical Director - Florida Medicare Plans** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... Florida near our Miami or Tampa locations.** The **Medical Director ** will support the following Florida Medicare ...+ Ensure timely and accurate completion of reviews in compliance with state and federal regulations, NCQA, and company… 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 ... and Utilization Management Strategy support * Collaborative work with Medicare Quality and Compliance on an ongoing basis * Develop subject matter expertise… more
- Molina Healthcare (Sterling Heights, MI)
- …to meet critical needs + Escalates gaps and barriers in implementation and compliance to AVP, VP and senior management + Consultative role, develops business case ... methodologies for programs, develops and coordinates implementation of business strategy + Collaborates and facilitates activities with other units at corporate and Molina Plans. **JOB QUALIFICATIONS** **Required Education** Bachelor's degree or equivalent… more
- OhioHealth (Columbus, OH)
- …Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position ... will be responsible for ensuring the appropriate governmental ( Medicare and Medicaid) reimbursement is received for OhioHealth. * This position is primarily… 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 ... they need for healthy living. JOB SUMMARY : The Medicare MAP Advisor- Will promote and sale MAP and...additional marketing locations while adhering to company regulatory guidelines. Compliance + Requires continues education to stay abreast on… more
- Humana (South Miami, FL)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll… more
- Cleveland Clinic (Cleveland, OH)
- …the Federal Clinical Trials Policy. In this role, you will report to the Director of Research Medicare Coverage Analysis and ensure compliant research billing ... financial services, clinical research billing office, IRB and research compliance related to Medicare coverage analysis issues...clinical trials for research billing. + Assist the MCA Director on the development of tools and billing grids… more
- Community Health Systems (La Follette, TN)
- …are submitted in accordance with regulatory guidelines and organizational policies. The Medicare Billing Specialist supports compliance with federal and state ... **Job Summary** The Medicare Billing Specialist is responsible for performing timely...Ensures documentation and billing practices align with audit and compliance expectations. + Escalates unresolved billing issues or delays… more
- Commonwealth Care Alliance (Boston, MA)
- …at this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance , Healthcare Medical Claims Coding ... reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance , Payment Integrity and Analytics… more
- UCLA Health (Los Angeles, CA)
- …of our Medicare Advantage products. In this role, you'll partner with the Director of Medicare Product Development and Bids to guide the annual bid process, ... drive cross-functional initiatives, and ensure product accuracy and compliance throughout the member lifecycle. Key Responsibilities: + Lead end-to-end Medicare … more
- SUNY Upstate Medical University (Syracuse, NY)
- …resources. Ensure accurate coding and documentation to support quality initiatives and Medicare compliance . Work closely with clinical teams across seven Primary ... Nurse (RN), or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) across seven Primary Care clinics. This role… more
- Fallon Health (Springfield, MA)
- …in our service area, and who have MassHealth Standard, and may have Medicare . It combines MassHealth (Medicaid) and Medicare benefits, including prescription ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief summary of purpose:**… more
- Henry Ford Health System (Traverse City, MI)
- …and planning and marketing support. Coordinate the development and implementation of Medicare Advantage sales strategies, compliance activities and oversight for ... SUMMARY: Responsible for the retention and growth of the Medicare line of business (both Individual and Group) accounting...daily operations. Bring concerns and pending issues to the Director in a timely manner for balanced resolutions. +… more
- Houston Methodist (Katy, TX)
- …Access Services, and Utilization Review as needed to ensure operational billing compliance with government/regulatory agencies and the Medicare and Medicaid ... position provides guidance to staff and is responsible for staffing, budget compliance , contributing to staffing decisions such as hiring and terminating employment,… more
- Ankura (New York, NY)
- …, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment. The Senior Director ... following types of activities: + Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance , audit, and investigation projects… more
- Hospice Of San Joaquin (Stockton, CA)
- …Caregivers are the focus of everything we do. We seek a Dynamic, self-motivated Director of Quality and Compliance who thrives in a fast-paced environment and ... supports our mission. JOB SUMMARY AND SCOPE The Director of Quality and Compliance (DQC) develops,...Board of Directors. w) Ensure the EMR system maintains compliance with changing Medicare Conditions of Participation… more
- Ankura (NC)
- …Ankura's Disputes and Economics Healthcare practice is seeking an experienced Managing Director for our payer government programs compliance & operations ... A strong working knowledge of laws, regulations and industry trends impacting compliance ( Medicare , Medicaid, ACA, government programs) and operations at health… more
- Trinity Health (West Springfield, MA)
- …Improvement Plan for the PACE Organization (PO) and ensure overall CMS regulatory compliance . The Director , Quality Improvement and Compliance , in ... including leading quality initiatives and projects. In addition, the Director ensures that data is collected from appropriate sources,... with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance… more
