- Humana (Carson City, NV)
- **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 (Carson City, NV)
- …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 (Carson City, NV)
- …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
- Humana (Carson City, NV)
- **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 (Carson City, NV)
- …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 (Carson City, NV)
- **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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Evolent (Carson City, NV)
- …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
- Evolent (Carson City, NV)
- …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 (Carson City, NV)
- …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 (Carson City, NV)
- …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 (Carson City, NV)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director you will be a key member of the utilization management team. ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Humana (Carson City, NV)
- …experience for our associates, members and providers. As the Resolution Team Operations Director ( Director , Grievance and Appeals), you will be accountable for ... starting your FIRST day of employment. Benefits include: + Medical Benefits + Dental Benefits + Vision Benefits +...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Prime Therapeutics (Carson City, NV)
- …and drives every decision we make. **Job Posting Title** Trade Client Relations Director - Remote **Job Description** The Trade Client Relations Director is ... responsible for the analysis, modeling and delivery of innovative pharmacy and medical rebate strategies and cost saving solutions to Prime's clients to ensure Prime… more
- Humana (Carson City, NV)
- …us put health first** Humana is seeking a strategic and experienced Director of Business Performance Management, to lead the development, implementation, and ... effectiveness, compliance, and the achievement of key business objectives. The Director will be responsible for establishing clear performance metrics, driving… more
- Humana (Carson City, NV)
- …of our caring community and help us put health first** The Director , Risk Adjustment Strategy Advancement will provide business intelligence and strategic planning ... support for business segments and the company at large. The Director , Risk Adjustment Strategy Advancement requires an in-depth understanding of how organization… more
- Otsuka America Pharmaceutical Inc. (Carson City, NV)
- Director of Field Reimbursement Management (FRM) Position Overview We are seeking an experienced, transformative leader to serve as the Director of Field ... compliance and risk management Preferred Skills + Comprehensive knowledge of Medicare , Medicaid, and commercial insurance reimbursement regulations + Experience with… more
- CenterWell (Carson City, NV)
- …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
- Evolent (Carson City, NV)
- …as we solve complex business problems. **Collaboration Opportunities:** The Director , Actuarial Services utilizes and develops analytical tools to solve ... impact on the organization and patient health. This role supports both medical cost management activities and business development efforts. **What You Will Be… more
- Humana (Carson City, NV)
- …the core of this evolution is Humana's Insurance Segment, which provides Medicare Advantage, Medicaid, and other health plans to millions. By integrating insurance ... a pivotal role in defining the future of Humana's Medicare and Medicaid businesses, which generate the majority of...to execution **Additional Information** This role reports to the Director of Strategy, works collaboratively with members of rest… more
- Prime Healthcare (Reno, NV)
- …+ One to Three years Management experience + Knowledge of Accounts Receivable, Medicare , Medical , HMO/PPO, and W/C Billing & Collections preferred. + Proficient ... committed to our core values of quality, compassion and community! Saint Mary's Medical Group is affiliated with Saint Mary's Regional Medical Center, one… more