- Molina Healthcare (Louisville, KY)
- …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 (Louisville, 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
- Molina Healthcare (Louisville, 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
- Humana (Louisville, KY)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll… more
- Molina Healthcare (Louisville, KY)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... (TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- Molina Healthcare (Louisville, KY)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health...National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the… more
- Molina Healthcare (Louisville, KY)
- …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
- Humana (Louisville, 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
- 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
- Humana (Louisville, KY)
- …part of our caring community and help us put health first** The Associate Director , IT Talent Management serves as the strategic leader who will deliver programs to ... development and delivery of executive-ready communications and presentations. The Associate Director , IT Talent Management must be a strategic leader and will… more
- Molina Healthcare (Louisville, KY)
- …and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct management and ... recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region. * Leads preparation… more
- Signature Healthcare (Louisville, KY)
- …development on data points, ie referral conversion rate, referral growth rate, Medicare market share. Establish appropriate processes and goals to achieve the ... and Signature Perks include the following and more! + Medical , Dental and Vision - Voluntary Life/Disability + Free...and Vision - Voluntary Life/Disability + Free Telemedicine with Medical Plan + 401(K) and Roth 401(K) + Tuition… more
- CenterWell (New Albany, IN)
- … medical expertise with the care team through daily huddles. + Helps Regional Medical Director and Clinic Manager in setting a tone of cooperation in practice ... Doctors, Advanced Practice professionals, Pharm D, Care Coach Nurses, Medical Assistants, Behavioral Health, Specialists, Quality Based Coders, Referral Coordinators… more
- Gentiva (Jeffersonville, IN)
- …hospice sites. + **Ensure Regulatory Excellence:** Maintain compliance with Medicare , state licensing, accreditation, and federal regulations; manage readiness for ... and long-term care settings. + **Team Leadership:** Supervise executive directors, medical staff, volunteer programs, and interdepartmental teams to optimize care… more
- BrightSpring Health Services (Louisville, KY)
- …preferred) and be familiar with online claims processing and Medicaid and Medicare billing practices. We offer: DailyPay Flexible schedules Competitive pay Health, ... processes and system requirements and seeks resolution from originator, supervisor or director + Performs outbound courtesy calls as designated by the business… more
- Waystar (Louisville, KY)
- …and innovative payer strategies. This role will report to the Sr Director of Product Operations. **WHAT YOU'LL DO** **Payer Relationship Management:** + Identify ... systems, and is connected to over 5K commercial and Medicaid/ Medicare payers. We are deeply committed to living out...+ bonus, if applicable) + Customizable benefits package (3 medical plans with Health Saving Account company match) +… more
- ChenMed (Louisville, KY)
- …+ 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
- Signature Healthcare (Louisville, KY)
- …facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded as a certified Great ... Local Standards, guidelines and regulations and as required by Director of Nursing. + Confirm that all nursing personnel...and Signature Perks include the following and more! + Medical , Dental and Vision - Voluntary Life/Disability + 401(K)… more
- Signature Healthcare (Louisville, KY)
- …facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded as a certified Great ... Local Standards, guidelines and regulations and as required by Director of Nursing. + Confirm that all nursing personnel...and Signature Perks include the following and more! + Medical , Dental and Vision - Voluntary Life/Disability + 401(K)… more
- Waystar (Louisville, KY)
- **ABOUT THIS POSITION** This role reports to a Director , Product Management and work closely with User Experience team and Technology teams. The Sr. Product Manager ... systems, and is connected to over 5K commercial and Medicaid/ Medicare payers. We are deeply committed to living out...+ bonus, if applicable) + Customizable benefits package (3 medical plans with Health Saving Account company match) +… more