- Daiichi Sankyo, Inc. (Bernards, NJ)
- …of all channels of managed care environment in the US (commercial, Medicare , Medicaid , etc.); preferredSufficient understanding of financial matters to challenge ... to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class...diseases and immune disorders. SummaryThe purpose of the Senior Director , Forecasting & Business Analytics is to lead the… more
- Novo Nordisk Inc. (WA)
- …to: Tax, Trade, Intellectual Property, Supply Chain, Private Health Insurance, Medicare , Medicaid , Reference Pricing, Pricing / Price Increases, Reimbursement, ... in Plainsboro, NJ or Washington, DC. The Position The Director - US Tax, Trade, IP works on complex...well as other Market Access & Public Affairs teams, Medical , Legal, Compliance, Communications and other key stakeholders locally… more
- Elevance Health (Costa Mesa, CA)
- ** Medical Director - Medicare and Medicaid ** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... required by law. **Candidates must live in California.** The ** Medical Director ** will be responsible for utilization...will be responsible for utilization review case management for Medicare and Medicaid in the California market… more
- ChenMed (Richmond, VA)
- …years' previous experience as Medical Director or equivalent with a Medicare or Medicaid patient population + Board eligibility is required. + Board ... preferred. + Preferred to be an existing high performing PCP partner and/or Medical Director within the ChenMed core model, with a proven ability to manage a… more
- Robert Half Finance & Accounting (Eatontown, NJ)
- …company located in Eatontown and offers a hybrid schedule, has an opportunity for a Director Medicare / Medicaid Reimbursement. + The Director will have ... above. + Planning, preparing and reviewing of the annual Medicare / Medicaid cost reports filings. In partnership with...partnership with the Vice President of Corporate Reimbursement, the Director will manage the completion of DSH, Medicare… more
- Humana (Lansing, MI)
- …development for our Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad ... efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large.… more
- Commonwealth Care Alliance (Boston, MA)
- …have):** + 7+ years of Healthcare experience, specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical ... operations, health care reimbursement, public health care programs and reimbursement methodologies ( Medicaid and Medicare ) + Medical Coding, Compliance,… more
- OhioHealth (Columbus, OH)
- …**Job 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… more
- Humana (Olympia, WA)
- …of the managed care industry including Medicare Advantage and Managed Medicaid . + Utilization management experience in a medical management review ... caring community and help us put health first** The Medical Director relies on medical ...organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national… more
- Molina Healthcare (San Antonio, TX)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs ... to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight, monitoring… more
- Humana (Carson City, NV)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must… more
- Humana (Little Rock, AR)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products +… more
- Humana (Raleigh, NC)
- … PLAN AND THE IDEAL CANDIDATE MUST RESIDE IN NORTH CAROLINA. The North Carolina Medicaid Provider Services Director leads a team that is accountable for growing ... efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large.… more
- Molina Healthcare (St. Petersburg, FL)
- …in accordance with the standards and requirements established by the Centers for Medicare and Medicaid . This position will provide direct support to the ... UM, Case Management, Claims, and other departments within Molina Medicare and Medicaid regarding A&G operations and... program knowledge. * Experience reviewing all types of medical claims (eg HCFA 1500, Outpatient/Inpatient UB92, high dollar… more
- Molina Healthcare (Madison, WI)
- …State Medical License without restrictions (free of sanctions from Medicaid or Medicare ) **PREFERRED EDUCATION:** Master's in Business Administration, Public ... HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + Previous… more
- Molina Healthcare (Fort Worth, TX)
- …adequacy, and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct ... of, various managed healthcare provider compensation and VBP methodologies, primarily across Medicaid and Medicare lines of business, including but not limited… more
- Idaho Division of Human Resources (Boise, ID)
- …position will be located at our downtown Boise office and report to the Deputy Director and will have primary oversight of Medicaid areas supporting work across ... knowledge of state and federal Medicaid requirements, including Title XIX ( Medicaid ), Title XXI (CHIP), and Title XVIII ( Medicare ). Typically gained by… more
- AmeriHealth Caritas (Southfield, MI)
- …and authorizations, including home- and community-based programs. + Collaborate with the Medical Director and care team to develop and monitor treatment ... Medicare LTSS Care Coordinator manages care coordination for Medicare beneficiaries with complex medical , behavioral health,...role ensures that care is delivered by Centers for Medicare & Medicaid Services (CMS), state, and… more
- RWJBarnabas Health (Oceanport, NJ)
- … will serve as a key resource to department leadership for providing Medicare and Medicaid reimbursement support and implementing government payment strategies ... This includes planning, preparing and reviewing of the annual Medicare / Medicaid cost reports filings. In partnership with...with the Vice President of Corporate Reimbursement , the Director will manage the completion of DSH, Medicare… more
- Humana (Columbus, OH)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... to speak up and voice opportunities to improve the member experience. Advises Director of Consumer Engagement and OH Market leaders to develop functional strategies… more
