- Elevance Health (Indianapolis, IN)
- Anticipated End Date: 2025-07-31 Position Title: RFP Development Director , Medicaid Clinical Strategies Job Description: The Medicaid Growth Office is ... Clinical Strategies and Solutions for all new and renewing Medicaid state RFPs. This RFP Development Director ...RFP outcomes. This position will work a hybrid model ( remote and office) from any US Elevance Health corporate… more
- Molina Healthcare (Long Beach, CA)
- …therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics ... outreach and coordination of services, including MTM services for Medicare and Medicaid eligible members as well as Medication Adherence Programs for STAR, HEDIS… more
- Caritas Family Solutions (Caseyville, IL)
- …Disability *Tuition Assistance Program *Real Work/Life Balance Hours worked (typical): 40 Remote Work: * Remote only allowed when on call. EEO Classification: ... Supervisor is responsible for daily operations of CILA home, client medical management and personnel management. ESSENTIAL DUTIES AND RESPONSIBILITIES include the… more
- RIT Solutions, Inc. (New York, NY)
- …criteria, Interqual, Milliman, or Health Plan specific guidelines Collaborate with the Medical Director to ensure the integrity of adverse determination notices ... Job Title: UM Nurse (California License) - Must be licensed in California- Remote Opportunity Work Hrs : (8am - 5pm PDT) would like to include evening, weekend and… more
- Northern Rivers Family of Services (Albany, NY)
- …services to children (up to age 21) and their caregivers through this Medicaid - funded program. You will provide services to children and their families in ... plan. You will report to the Clinical Supervisor/ Clinical Director . You will work a hybrid schedule, combining on-site...You will work a hybrid schedule, combining on-site and remote work, with up to 25% community travel and… 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
- Humana (Phoenix, AZ)
- **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 Medicaid requirements, and… 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 ... state reports are completed timely and accurately. The Provider Services Director requires an in-depth understanding of how organizational capabilities interrelate… 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
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