- Elevance Health (Cincinnati, OH)
- ** Medicare Medical Director ** Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while ... Candidates must be able to work Eastern Time Zone hours. The ** Medicare Medical Director ** is responsible for the administration of physical and/or… more
- Molina Healthcare (Cincinnati, OH)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Cincinnati, OH)
- **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
- Molina Healthcare (Cincinnati, OH)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... State Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- Genesis Healthcare (Crestview Hills, KY)
- …Powerback is the place for you. **Why Powerback?** + **Benefits:** We offer Medical , Dental, and Vision plans to Full-Time and Part-Time team members. + **Support ... our Clinicians in Action professional development program. Responsibilities The Director of Rehab PTA is responsible for the efficient...period of one year. 5. A thorough knowledge of Medicare and third party billing is also required. Posted… more
- Molina Healthcare (Cincinnati, OH)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the ... to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight, monitoring and… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …specific to hospital revenue cycle risk areas highlighted by the OIG, Medicare , State Medicaid, State Insurance Fraud; Managed Care or Governmental Value-Based ... risk areas + Assists in auditing and investigations requested by the System Director , Compliance. + Assists in the development of compliance corrective action plans… more
- Option Care Health (Cincinnati, OH)
- …and delivering presentations within Option Care and externally with customers (ex. medical director , head of case management, executive c-suite individuals). ... oncology, or transplant. + Basic understanding of billing and reimbursement procedures for hospital, medical offices, and Medicare (B/D + benefits) as well as … more
- Molina Healthcare (Cincinnati, OH)
- …Tighter knit proximity ongoing after contract. * In conjunction with Director /Manager, Provider Contracts, negotiates Complex Provider contracts including but not ... and/or language. Assists with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region. * Advises Network Provider Contract… more
- ChenMed (Cincinnati, OH)
- …+ Implements strategic planning for referral coordination that contributes to medical cost reduction and improves organizational performance. + Interviews Referral ... to improve referral outcomes. + Participates in executive team and Network Director meetings to collaborate for referral improvements and solutions. + Travels to… more