- Molina Healthcare (Albuquerque, NM)
- …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
- Humana (Santa Fe, NM)
- …lead Medical Directors performing utilization management for inpatient authorizations training medical director team to assist and facilitate new hires and ... remediation of medical directors performing Medicare utilization management processes...rate with denials and overturns. Deliver the upmost consistent medical director decision making. + _Internal Operations… more
- Evolent (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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
- Evolent (Santa Fe, NM)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... with cross-functional teams, including **clinical reviewers, product, management, and senior leadership,** to improve decision-making and care outcomes. + Assist… more
- Humana (Santa Fe, NM)
- …We are seeking an experienced and strategic leader to fill the position of Director of Internal Pharmacy Forecasting and Performance Analytics. This role will lead a ... of five direct reports and 1-2 indirect reports. The Director will play a key role in driving business...leader will need deep understanding of the complexities of Medicare Part D benefit design and regulatory changes to… more
- Humana (Santa Fe, NM)
- …of our caring community and help us put health first** The Director , Actuarial Analytics/Forecasting analyzes and forecasts financial, economic, and other data to ... short, medium and long-term financial and competitive position. The Director , Actuarial Analytics/Forecasting requires an in-depth understanding of how organization… more
- CenterWell (Santa Fe, NM)
- …MSSP, and future models. Under general direction and supervision from the ACO Director , the Senior Strategy Advancement Professional will bring a combination of ... an in-depth understanding of the healthcare industry, including value-based care, Medicare , population health, Accountable Care Organizations (ACOs), medical … more
- Humana (Santa Fe, NM)
- …community and help us put health first** We are seeking a highly skilled Director , Program Management to oversee the development and execution of a new eCommerce ... managing complex projects independently, ensuring alignment with strategic objectives. The Director will play a key role in establishing the structure, frameworks,… more
- Molina Healthcare (Albuquerque, NM)
- …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
- CenterWell (Santa Fe, NM)
- …Leaders to identify and influence enhancements to technology to improve the medical coder experience. + Oversees coding operations by identifying business partner ... of management experience + 8 or more years of Medical Coding, IPA, or similar experience + Medical...up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track record… more
- Humana (Santa Fe, NM)
- …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
- Evolent (Santa Fe, NM)
- …ongoing surveillance of coding updates from authoritative sources, including the American Medical Association (AMA), Centers for Medicare & Medicaid Services ... Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Senior Scope Analyst, Scope Management** The Specialty Scope Management team is made up… more