- Humana (Springfield, IL)
- **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...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Springfield, IL)
- …to adapt and the courage to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The Medical ... caring community and help us put health first** The Medical Director relies on medical ...Medical Directors will learn North Central region state Medicaid requirements (currently VA, KY, OH, IN, WI) and… more
- CVS Health (Springfield, IL)
- …do it all with heart, each and every day. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout ... Better Health Plan of Illinois. This UM (Utilization Management) Medical Director will be a "Work from..."Work from Home" position primarily supporting the Aetna Illinois Medicaid plan and the UM team ; but… more
- Humana (Springfield, IL)
- …party reporting including notification, collection, analyze, storage, and distribution. + Team representative and presenter for various Medicaid committee ... caring community and help us put health first** The Associate Director , Procurement generates and implements efficient sourcing and category management strategies.… more
- Humana (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Humana (Springfield, IL)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture** + **Knowledge and experience with national guidelines… more
- Humana (Springfield, IL)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture + Knowledge and experience with national guidelines… more
- Rush University Medical Center (Chicago, IL)
- …Associate Vice President of System Laboratory Services with a dotted line to the Medical Director , Rush Medical Laboratories (RML). The Administrative ... attend these meetings and communicate progress/issues to the AVP and the Laboratory Medical Director ; meet with vendors as necessary to negotiate system… more
- Humana (Springfield, IL)
- …and related tasks; works under minimal supervision; and assists in supporting the medical director team and leaders in meeting enterprise-wide business ... community and help us put health first** The Corporate Medical Director (CMD) relies on medical...+ Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products + Must be passionate about… more
- Evolent (Springfield, IL)
- …meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management ... team . We can offer you a meaningful way to...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management ... team . We can offer you a meaningful way to...timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to… more
- Evolent (Springfield, IL)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... will be a key member of the utilization management team . We can offer you a meaningful way to...Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Humana (Springfield, IL)
- …part of our caring community and help us put health first** The Director , Internal Audit develops, plans and evaluates internal audit programs for the organization's ... ensure compliance with the organization's policies, procedures and standards. The Director , Internal Audit requires an in-depth understanding of how organization… more
- Humana (Springfield, IL)
- …for Medicare & Medicaid Services (CMS) and Humana's Illinois locations for team engagement meetings. + **Direct Reports:** Up to 8. **WAH Internet Statement** To ... and behavior health professionals responsible for care management. The Associate Director , Care Management requires a solid understanding of how organizational… more
- Aveanna Healthcare (Fairview Heights, IL)
- …to the Governing Body, also reporting to Area Vice President, AVP, and/or Area Director , AD. Essential Job Functions Team Management: * Assure evaluation of each ... Executive Director - Home Care ApplyRefer a FriendBack Job...or without notice. As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements… more
- Humana (Springfield, IL)
- …a part of our caring community and help us put health first** The Director , IT Portfolio Management & Agile Services collaborates with the business portfolio team ... instill enterprise-wide adoption of Agile methodologies and practices. The Director requires an in-depth understanding of how organizational capabilities interrelate… more
- ChenMed (Oak Lawn, IL)
- …preferred. + Strongly prefer one (1) years' previous experience as Medical Director or equivalent with a Medicare or Medicaid patient population + Board ... expanding and we need great people to join our team . The Associate Market Clinical Director will...to be an existing high performing PCP partner and/or Medical Director within the ChenMed core model,… more
- AbbVie (Mettawa, IL)
- …medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's ... and Tik Tok (https://www.tiktok.com/@abbvie) . Job Description Primary Job Function The Director , US Tx Strategic Pricing, will be responsible for calculating and… more
- Ascendis Pharma (IL)
- …with US payers, including both commercial and public payers such as Medicare and Medicaid . + Collaborate with commercial and medical in responding to external ... employees to grow and develop their skills. The National Director , Field HEOR serves as a strategic scientific liaison...+ Participate in payer account planning with Market Access team . + Maintain account plans and update medical… more