- Novo Nordisk Inc. (WA)
- …potential? This role can sit in Plainsboro, NJ or Washington, DC. The Position The Director - US Tax, Trade, IP works on complex issues that will require an in-depth ... globally. Relationships Reports to the Market Access and Public Affairs Senior Director , Policy. Other internal relationships include a dotted line with Corporate… more
- Humana (Olympia, WA)
- **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- CVS Health (Hartford, CT)
- …the US. Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part C appeals (both provider and ... * Board Certified in ABMS or AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- Humana (Carson City, NV)
- **Become 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 be passionate… more
- Elevance Health (Costa Mesa, CA)
- ** Medical Director - Medicare and...and expectations for time onsite will be discussed as part of the hiring process. The health of our ... 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 while also… more
- Humana (Little Rock, AR)
- **Become 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 + Must be… more
- CVS Health (Boston, MA)
- …actuarial analytics and pricing. The ideal candidate will have deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing ... Key Responsibilities: + Lead the development and execution of actuarial analytics strategies for Medicare Advantage and Part D programs. + Inform and enhance the… more
- Humana (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Clinical Pharmacist Lead monitors drug development pipeline, and medical literature, ... diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and monitors… more
- Bristol Myers Squibb (Princeton, NJ)
- …and analysis. **Responsibilities:** + Consolidate and maintain GTN projections for Commercial, Medicare Part D, and GPO contracted accounts + Coordinate inputs ... personal lives. Read more: careers.bms.com/working-with-us . **Summary:** The Commercial & Medicare Channel Lead will manage forecasting and analytics for the… more
- OhioHealth (Columbus, OH)
- …matter expert in the following areas, S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, Indirect Medical Education, Graduate Medical ... belief system.** We believe wellness and sickness are both part of a lifelong partnership, and that everyone could...This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities.… more
- Centene Corporation (Queens, NY)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... will lead and support the expansion and optimization of Medicare -focused VBP arrangements across New York. This role is...position will be responsible for working with the VBP Director , other VBP Managers, and Analysts, as well as… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …product development, operations, financing and revenue generating programs + Knowledge of Medicare Part D program, operations and industry trends + Proven ... The Medicare Risk Adjustment Strategy Program Manager will report to the Senior Director of Medicare Risk Adjustment and Analytics. This role will manage the… more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: Responsible for the retention and growth of the Medicare line of business (both Individual and Group) accounting for more than $400 million in ... planning and marketing support. Coordinate the development and implementation of Medicare Advantage sales strategies, compliance activities and oversight for both… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following ... SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided… more
- Humana (Salem, OR)
- **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...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … more
- Humana (Charleston, WV)
- …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Bismarck, ND)
- **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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- CareOregon (Portland, OR)
- …is a federal contractor and must comply with all federal laws. Job Title Medical Director , NP - Primary Care Requisition # 25064 Exemption Status Exempt ... costs and increase provider satisfaction. We are a proud part of the CareOregon family of health organizations. Our...Physicians, Physician Assistants and Nurse Practitioners Manager Title Sr Medical Director - Clinical Services HCP Department… more
- CareOregon (Portland, OR)
- …is a federal contractor and must comply with all federal laws. Job Title Medical Director - Hospice Requisition # 25073 Exemption Status Exempt Management Level ... 10% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This Hospice Medical Director role is primarily remote, with 60%… more
- Evolent (Jackson, MS)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
