- MetroPlusHealth (New York, NY)
- …the medical necessity of requested healthcare services Communicates with Medical Director regarding all inpatient cases and outpatient/ambulatory requests ... list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus… more
- Children's Health (Dallas, TX)
- …of the medical staff. * In collaboration with the Sr. Director participates in and represent divisional activities in various designated health systems ... position will work 3 days onsite and 2 days remote weekly Why Children's Health? At Children's Health, our...Texas. Assist both the Manager of Accreditation and Sr. Director in overall continual regulatory readiness and compliance with… more
- Ability and Choice Services, Inc. (Salt Lake City, UT)
- …at $16.00-$17.00/hour . We also offer great full-time benefits that include low cost medical plans . If this sounds like the right opportunity in the essential human ... maintain open and honest communications with the Supported Employment Director . You provide each service recipient's work schedule to...of abuse, exploitation, or other related offenses on the Medicaid Exclusion list or any felony in the last… more
- Teva Pharmaceuticals (Parsippany, NJ)
- Senior Director Federal National Accounts & Medicaid - Remote Date: Jul 23, 2025 Location: Parsippany, United States, New Jersey, 07054 Company: Teva ... to make a difference with. **The opportunity** The Sr Director leads a team of three individuals responsible for...of Teva's biosimilar and brand portfolio products across State Medicaid and Federal National Accounts. The position is responsible… more
- Molina Healthcare (Fort Worth, TX)
- …Committees. * Manages and reports network adequacy for Medicare, Marketplace, and Medicaid services. * In conjunction with direct management and senior leadership, ... re-contracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region. * Leads preparation… more
- Elevance Health (Richmond, VA)
- … to align to our Clinical Strategies and Solutions** for all new and renewing Medicaid state RFPs. This RFP Development Director is a pivotal role designed to ... The Medicaid Growth Office is looking to hire a...as the reduction of diabetes incidents, the RFP Development Director will craft exceptional and tailored responses that address… more
- Humana (Springfield, IL)
- …first** The Clinical Pharmacist Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes ... diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and monitors… more
- Humana (Sterling Heights, MI)
- …caring community and help us put health first** The Quality Improvement Director provides strategic leadership for Humana's Michigan Medicaid Quality Improvement ... the local health plan lead for accreditation compliance. The Quality Improvement Director oversees all aspects of the plan's Quality Assurance and Performance… more
- CVS Health (Oklahoma City, OK)
- …is a remote -based (work from home) role.** In this role as Medical Director (Behavioral Health), you will: * Provide leadership and day-to-day physician ... utilization management team, including the management of high-risk cases and medical necessity decisions * Provide comprehensive behavioral health care management to… more
- RWJBarnabas Health (Oceanport, NJ)
- Director , Corporate Reimbursement (Hybrid/ Remote ) - Oceanport, NJReq #:0000180233 Category:Professional / Management Status:Full-Time Shift:Day ... $209,501.00 per year Location: Oceanport, Oceanport, NJ 07052 Job Title: Director Location: Barnabas Health Corp Department: Corporate Reimbursement Req#: 0000180233… 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 ... for One Year Term **_This position is available to remote employees residing in Massachusetts. Applicants residing in other...7+ years of Healthcare experience, specific to Medicare and Medicaid + 7+ years progressive experience in medical… more
- Idaho Division of Human Resources (Boise, ID)
- …This position will be located at our downtownBoiseoffice and report to the Deputy Director and will have primary oversight of Medicaid areas supporting work ... Medicaid Deputy Administrator - MED Posting Begin Date:...End Date: 2025/07/31 Category: Administration Work Type: Full Time Remote : Flexible Hybrid Location: Boise, ID, United States Minimum… more
- OhioHealth (Columbus, OH)
- …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 responsible for… more
- Evolent (Washington, DC)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... improvement, and clinical excellence. + **This position is 100% Remote and can be completed from any state. Multiple...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… more
- Humana (Columbus, OH)
- …to speak up and voice opportunities to improve the member experience. Advises Director of Consumer Engagement and OH Market leaders to develop functional strategies ... to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be… more
- Molina Healthcare (San Antonio, TX)
- …standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the ... or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight, monitoring and training of… more
- Teva Pharmaceuticals (Parsippany, NJ)
- Director National Accounts, ESI/Ascent Lead - Remote Date: Jul 23, 2025 Location: Parsippany, United States, New Jersey, 07054 Company: Teva Pharmaceuticals Job ... excellent organization skills. + Knowledge of Regional and National Commercial Payers, Medicaid , Medicare, and GPOs + Understanding of Medical , Pharmacy, and… more
- Humana (Montpelier, VT)
- **Become 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 work assignments involve moderately complex to complex issues...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Integra Partners (Troy, MI)
- Position Summary + Integra Partners is seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a salaried, ... Job Responsibilities: + Conducting timely clinical review of Durable Medical Equipment (DME) requests in alignment with Medicare/ Medicaid...Management Nurse will route the case to the UR Medical Director . The UR Medical … more
