- Humana (St. Paul, MN)
- **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (St. Paul, MN)
- …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
- Humana (St. Paul, MN)
- …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
- CVS Health (St. Paul, MN)
- …We are looking for a Principal Data Scientist to join our Aetna Medicare (STARS Portfolio) team at CVS Health. This high-level individual contributor will partner ... closely with the Executive Director of Aetna STARS Analytics to drive hands on...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- Humana (St. Paul, MN)
- **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (St. Paul, MN)
- …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, DME, skilled nursing facility and waiver requests. The Medical Director provides medical interpretation...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (St. Paul, MN)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (St. Paul, MN)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Evolent (St. Paul, MN)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Humana (St. Paul, MN)
- …part of our caring community and help us put health first** The Director of Regulatory Compliance develops and implements compliance programs aimed at governmental ... requirements and regulations across Humana Specialty and Military products. The Director manages dedicated compliance teams of associates who oversee compliance… more
- Evolent (St. Paul, MN)
- …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. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (St. Paul, MN)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (St. Paul, MN)
- …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 ... recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (St. Paul, MN)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a key member of the utilization ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- CVS Health (St. Paul, MN)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...medical license. Internal Medicine background Have experience in Medicare and Medicaid **Education** *M.D. or DO, Board Certification… more
- Gentiva (White Bear Lake, MN)
- …to patient's/families/caregivers. + Collaborate with Nurse Practitioner, PCP, and/ or Medical Director to address patient needs. **About You** **Registered ... to give people the care they need with dignity, grace, and love. The **RN Director of Advanced Illness Management (AIM)** will report directly to the AVP of Advanced… more
- Evolent (St. Paul, MN)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... in Cardiology** (with Cardiology training and clinical experience). + **Unrestricted medical license** in the state of residence and willingness to obtain… more
- The Cigna Group (Bloomington, MN)
- **Job Description: Director for Regulated Markets - CDAG/ODAG** **Excited to grow your career?** We value our talented employees, and whenever possible strive to ... the difference in our success. **Role Summary** : The Director of Regulated Markets is responsible for Coverage Review...Markets is responsible for Coverage Review and Determinations for Medicare Part B and Part D, Medicaid, Marketplace or… more
- Humana (St. Paul, MN)
- …of our caring community and help us put health first** The Director , Provider Engagement develops and grows positive, long-term relationships with physicians, ... within the contracted working relationship with the health plan. The Director , Provider Engagement requires an in-depth understanding of how organization… more
- Elevance Health (Mendota Heights, MN)
- …budgeting, and implementing initiatives that enhance operational efficiency across Commercial, Medicare , and Medicaid markets. The Director plays a critical ... **Strategy & Program Development Director - Payment Integrity Strategy & Planning** **Location:**...and drive practical strategies as we seek to reduce medical costs is preferred. + Knowledge and experience in… more