- Novo Nordisk Inc. (WA)
- …health outcomes. Are you ready to realize your potential? The Position The Senior Director works on complex issues that require an in-depth knowledge of the company ... include all other Market Access & Public Affairs teams, Finance, Medical , Legal, Compliance, Communications and other key stakeholders locally and globally.… more
- Eisai, Inc (Miami, FL)
- …of the US healthcare system across one or more major payer segments ( Medicare , Medicaid, Federal, and Commercial).Experience working with medical and pharmacy ... At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides...Access. Working closely with and reporting to the Associate Director , Access and Reimbursement, the ARM, will be the… more
- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests ... for services. The Medical Director work assignments involve moderately complex...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Concord, NH)
- …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. ... The Behavioral Health Medical Director work assignments involve moderately complex...Medicare Advantage and managed Medicaid + Experience with national guidelines such as MCG(R), ASAM or InterQual +… more
- CVS Health (Hartford, CT)
- …based (work at home) based anywhere in the US. Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part C ... 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...in ABMS or AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance &… more
- Humana (Topeka, KS)
- …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
- Molina Healthcare (Ann Arbor, MI)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... staff services. Maintains a working knowledge of applicable national , state, and local laws and regulatory requirements affecting...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Humana (Honolulu, HI)
- …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
- Molina Healthcare (Columbus, GA)
- …3+ years HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
- Humana (Lansing, MI)
- …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
- 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 ... reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance, Payment Integrity and Analytics… more
- Community Health Systems (La Follette, TN)
- …Information Management, or related field preferred + 1-2 years of experience in Medicare billing, medical claims processing, or hospital revenue cycle operations ... **Job Summary** The Medicare Billing Specialist is responsible for performing timely...color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military… more
- Community Health Systems (Franklin, TN)
- Job Summary The Collections Specialist II - Managed Medicare is responsible for managing outstanding patient accounts, ensuring accurate and timely collections from ... self-pay patients. This role requires strong knowledge of insurance processes, medical billing, and collection regulations to maximize reimbursement and minimize bad… more
- Humana (Austin, TX)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... health, SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services… more
- Humana (Baton Rouge, LA)
- **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 specifically for DSNP. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Raleigh, NC)
- **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 , Physician - Primary Care Requisition # 25065 Exemption Status Exempt ... Direct Reports Physicians, Physician Assistants and Nurse Practitioners Manager Title Sr Medical Director - Clinical Services HCP Department Housecall PC Pay… more
- Rhythm Pharmaceuticals (Boston, MA)
- …adapt, learn, and our tenacity to overcome barriers, together. Opportunity Overview The National Account Director (NAD) will be a field-based strategic leader ... Part D payers. The NAD will develop and maintain relationships with national and regional Medicare payers, third-party administrators (TPAs), PBMs, employers… more
- CenterWell (Anderson, SC)
- …on teamwork and providing a positive and welcoming environment for all. The Associate Medical Director has similar job duties as a Physician, namely focusing on ... medicine, continuity of care, health maintenance, and disease prevention. The Associate Medical Director serves as a health-care professional and capable of… more
- CVS Health (Springfield, IL)
- …**Position Summary** CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director ( Medical Affairs). This is a remote based, work ... clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director ( Medical Affairs) will report into… more
