- Molina Healthcare (Lexington, KY)
- …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
- CVS Health (Frankfort, KY)
- …heart, each and every day. **Position Summary** Drive growth for Medicare Advantage External Distribution Partnerships by setting strategic sales goals, crafting ... winning strategies, and optimizing performance. Partner with senior leaders to deliver innovative solutions, streamline processes, and achieve measurable results.… more
- Molina Healthcare (Lexington, KY)
- **JOB DESCRIPTION** **Job Summary** Responsible for analysis of Medicaid and Medicare financial reports, trend, and opportunities. Includes evaluation of and ... recommendations relating to business opportunities, Medicare bids, investments, financial regulations, and similar financial projects...early signs of trends or other issues related to medical care cost. + Design and perform actuarial studies… more
- CenterWell (Frankfort, KY)
- …and high-risk Medicare patients within a full-risk, value-based framework. The Medical Director collaborates in a dyad partnership with the Strategy ... community and help us put health first** The National Medical Director for Home-Based Care Programs is...medical direction, clinical oversight, and advancement of CenterWell Senior Primary Care's (and Conviva Senior Primary… more
- Evolent (Frankfort, KY)
- …Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to ... for utilization management while working in conjunction with the Senior Medical Director . **Qualifications -...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Frankfort, KY)
- …Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to ... for utilization management while working in conjunction with the Senior Medical Director . **Qualifications** +...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Frankfort, KY)
- …MD provider is recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Frankfort, KY)
- …MD provider is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization ... the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Humana (Frankfort, KY)
- …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 (Frankfort, KY)
- …satisfaction, engagement, and business value. We're looking for a customer-obsessed, results-driven Director of Product Design to lead the evolution of our digital ... focused on solving customer needs while enabling strategic and operational goals. As Director of Product Design, you'll lead a team of product designers while… more
- Baylor Scott & White Health (Frankfort, KY)
- … senior leadership, hospital senior leadership, and senior medical staff including denials from all payers, Medicare /Medicaid audit activities and key ... **Job Summary** The Director , Denial Resource Center is responsible for the...improved utilization of appropriate patient care services. Collaborates with medical , clinical, HIM and other BSWH departments to ensure… more
- Humana (Frankfort, KY)
- …benefits organizations in the country. The Insurance Strategy team supports Humana's Medicare and Medicaid lines of business. This business unit, Humana's largest, ... majority of the company's total revenue and earnings. Team members partner with the senior leaders of the business unit, and more broadly with leaders throughout the… more
- CVS Health (Frankfort, KY)
- …And we do it all with heart, each and every day. The Lead Director , National VBC Performance Planning & Insights will act as a strategic leader driving ... guide business decisions for national and local providers. The Director will also play a key role in supporting...efforts and adjusting strategies accordingly + Work closely with Medicare Quality team to ensure that reporting highlights areas… more
- CenterWell (Frankfort, KY)
- …, Informatics** will be responsible for supporting Patient Safety analytics on the Medicare population. The Associate Director is expected to perform and present ... of our caring community and help us put health first** The Associate Director , Informatics coordinates with other analytics, IT and business areas across the… more
- WelbeHealth (Frankfort, KY)
- …senior care by providing an all-inclusive care option to our most vulnerable senior population. The Director , Federal Government Affairs will lead a bold ... regulatory affairs function with Congress and the Centers for Medicare and Medicaid Services (CMS) + Develop and implement...uniquely cared for. + 401k + employer match + Medical insurance coverage ( Medical , Dental, Vision) starting… more
- Molina Healthcare (Lexington, KY)
- …activities for the state health plan. Works with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider ... and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct management and… more
- Humana (Frankfort, KY)
- …to deliver agile, data-driven, and personalized member experiences at scale. As Director of Marketing Communication Operations, you will play a pivotal leadership ... the AVP of Marketing Operations, you will shape strategic direction, influence senior stakeholders, and lead a high-performing team of marketers. You'll drive… more
- Humana (Frankfort, KY)
- …the core of this evolution is Humana's Insurance Segment, which provides Medicare Advantage, Medicaid, and other health plans to millions. By integrating insurance ... Strategy team plays a pivotal role in defining the future of Humana's Medicare and Medicaid businesses, which generate the majority of the company's total revenue… more
- CenterWell (Lexington, KY)
- … medical expertise with the care team through daily huddles. + Helps Regional Medical Director and Clinic Manager in setting a tone of cooperation in practice ... us put health first** Join a Team That's Redefining Senior Primary Care: Humana's Primary Care Organization is one...accordance with standards of care. + Follows level of medical care and quality for patients and monitors care… more
- Cardinal Health (Frankfort, KY)
- …and proactively provides guidance and trainings on policies. Reporting to the Director , Ethics & Compliance, this position supervises and manages audits to determine ... detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation… more