- UnitedHealth Group (Phoenix, AZ)
- …Connecting. Growing together. We are currently seeking an Inpatient Care Management Medical Director to join our Optum team. This team is responsible for conducting ... care. Our clients include local and national commercial employer, Medicare, and state Medicaid plans. The Medical Directors work with groups of nurses and support… more
- MetroPlusHealth (New York, NY)
- …list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus ... the medical necessity of requested healthcare services Communicates with Medical Director regarding all inpatient cases and outpatient/ambulatory requests for health… more
- CenCal Health (Santa Barbara, CA)
- …Reporting to the Chief Medical Officer, or his/her designee, the Medical Director is responsible for providing clinical oversight for utilization, quality, care ... and their service needs. This position will work a hybrid or remote schedule depending on business needs. Duties & Responsibilities Provides clinical leadership… more
- Children's Health (Dallas, TX)
- …4:00pm Job Type: On-site; this position will work 3 days onsite and 2 days remote weekly Why Children's Health? At Children's Health, our mission is to Make Life ... Health System of Texas. Assist both the Manager of Accreditation and Sr. Director in overall continual regulatory readiness and compliance with all standards and… more
- MetroPlusHealth (New York, NY)
- …list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus ... coordination and completion of special projects as appropriate. Coordinates Medical Director group email and chat functionality. Effectively communicates with all… more
- myPlace Health (Los Angeles, CA)
- …expert knowledge , including a strong understanding of community resources, Medicaid /Medicare, and public benefit programs to help participants thrive. Leading with ... Report to a supportive leader , with direct reporting to our Executive Director , ensuring guidance and collaboration every step of the way. Embrace local travel… more
- Ability and Choice Services, Inc. (Salt Lake City, UT)
- …well as maintain open and honest communications with the Supported Employment Director . You provide each service recipient's work schedule to the residential staff ... of abuse, exploitation, or other related offenses on the Medicaid Exclusion list or any felony in the last...45 days through paid self paced and instructor led remote learning Are you punctual and reliable? Can you… 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 (Nampa, ID)
- **Job Description** **Job Summary** The Strategy Advancement Director is responsible for advancing Molina's growth strategy and positioning the company for success ... in Medicaid , CHIP, DSNP, and Marketplace procurements. Reporting to the...ABD, DSNP, Foster Care, and DD/IDD). The Strategy Advancement Director works collaboratively across departments, including Product Development, Business… 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, ... of, various managed healthcare provider compensation and VBP methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to;… 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 (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
- Humana (Springfield, IL)
- …diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and monitors ... Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Illinois Medicare - Medicaid health plan. The individual leverages a broad understanding of managed care… more
- CVS Health (Oklahoma City, OK)
- …their clinical quality and effective use of health care resources. **This 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 oversight for utilization management team, including the management of high-risk cases and medical necessity decisions * Provide comprehensive behavioral health care management to facilitate… 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)
- 011250 CCA-Claims Hiring for One Year Term **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not ... this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr.… 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
- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA-Claims **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this ... time._** **Position Summary:** Reporting to the Director , Claims Operations and Quality Assurance, the Claims Sr....Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports… 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
