workflow solutions. Strong knowledge of healthcare regulatory requirements, including CMS interoperability, provider data...
innovative projects for program improvements. The manager understands and ensures regulatory requirements are met for UNOS, CMS...
We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. Yes, we share a mission that inspires. We need your organizational talents and business discipline to...
Experience with federal health care programs (e.g., VA, TRICARE, CMS) or a similarly highly regulated adjacent industry...
, governance, quality performance improvement, and CMS Star Ratings optimization, helping health plans navigate an increasingly..., forecasting models, and performance improvement plans Translate CMS regulations, methodology updates, and industry trends...
), CMS Stars, MSSP Performance, the CMS Quality Rating System (QRS), and other Quality Programs. Success is achieved... across all lines of business with a key focus on CMS Stars, MSSP, ACO REACH (Lead), MIPS, and client and state specific VBC quality...
Spend benefit programs. As the organization's subject matter expert on benefit design informed by CMS guidance... Serve as the company's thought leader and subject matter expert on Directed Spend benefit administration, CMS guidance...
standards, regulatory requirements, and Medicaid domain frameworks (e.g., MITA, CMS guidelines) across claims, eligibility... sector systems (e.g., Medicaid, eligibility systems, claims platforms) and frameworks such as MITA and CMS guidelines Solid...
to ICD-10, CMS-HCC, and state-specific risk methodologies Standardize best practices across employed and independent... networks Compliance & Audit Readiness Ensure compliance with CMS, HHS, and state regulatory requirements Partner...
efficient and effective care delivery to patients Maintain knowledge of current CMS and MCG evidence-based guidelines...