- Eisai, Inc (Houston, TX)
- …of the US healthcare system across one or more major payer segments ( Medicare , Medicaid, Federal, and Commercial).Experience working with medical and pharmacy ... At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides...Access. Working closely with and reporting to the Associate Director , Access and Reimbursement, the ARM, will be the… more
- Houston Methodist Hospital (Houston, TX)
- At Houston Methodist, the Director Case Management & Social Services RN position is responsible for strategy, function and operations of the Case Management & Social ... promoting the most cost-effective utilization of the hospital's resources. The Director Case Mgmt Social Svcs position deploys population-focused teams to enhance… more
- Molina Healthcare (Houston, TX)
- …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 (Houston, TX)
- …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 (Houston, TX)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- Molina Healthcare (Houston, TX)
- **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
- Houston Methodist (Katy, TX)
- …areas of Revenue Cycle, to include but not limited to: medical coding, insurance billing, collections, patient account resolution, appeals/denials, customer service, ... procedures, and provides quality reviews. Reports results of key performance metrics to director on a timely basis. **FINANCE ESSENTIAL FUNCTIONS** + Assists in the… more
- Molina Healthcare (Houston, TX)
- …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 (Houston, TX)
- …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
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Director Governmental Reporting is responsible for ensuring that Houston Methodist meets all internal and external financial and ... governmental reporting requirements. Requirements include Medicare cost reports, Federal Tax Returns Health and Human Services (HHS)/Centers for Medicare and… more
- ChenMed (Houston, TX)
- …is a transitional position towards becoming a center clinical P&L leader (ie, Senior Medical Director [SMD]) in the organization. The incumbent Center Medical ... organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a...simultaneously completing PCP Black Belt Training and Mastering the Medical Director Essentials within a combined and… more
- Molina Healthcare (Houston, TX)
- …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
- Danaher Corporation (Houston, TX)
- …the Danaher Business System which makes everything possible. The Field Reimbursement Director position is a provider / customer facing role responsible for ... coordinate and engage targeted customers within the US. Reporting to the Senior Director of Market Access Americas, this highly visible role will play a pivotal… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Director Managed Care Contracting position is responsible for the development, negotiation, maintenance and payer relations of the Houston ... managed care payers include commercial payers, separate transplant contracts, Medicare Advantage, Medicaid Health Maintenance Organizations (HMOs), International, behavioral… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Director Case Management & Social Services RN position is responsible for strategy, function and operations of the Case Management & Social ... promoting the most cost-effective utilization of the hospital's resources. The Director Case Mgmt Social Svcs position deploys population-focused teams to enhance… more
- AbbVie (Houston, TX)
- …medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's ... Texas + Austin, Texas + Denver, Colorado The Associate Director , Field Reimbursement, Botox Therapeutic manages and coaches a...understanding of Parts A, B, C and D or Medicare and associated reimbursement dynamics + Strong understanding of… more
- Molina Healthcare (Houston, TX)
- …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
- ChenMed (Houston, TX)
- …and runs referral team meeting- Create agenda for meeting. Gather info from Medical Director /Network Director /Referral Manager. + Prepares Referral ... Team Meeting Minutes and send minutes to Operation Director , Market Medical Director , Market...the communities served by ChenMed, including the complexities of Medicare programs to patients in the healthcare marketplace +… more
- Option Care Health (Houston, TX)
- …is maintained by providing direct patient care 20-40% of the time. In a Medicare Certified Home Health agency, this position may also serve as the alternate ... administrator and or alternate director of nursing. **Job Description:** **Job Responsibilities** (listed... of Nursing of the Home Health Agency for Medicare certified home health agencies in the absence of… more
- CenterWell (Houston, TX)
- … medical expertise with the care team through daily huddles. + Helps Regional Medical Director and Center Administrator in setting a tone of cooperation in ... Doctors, Advanced Practice professionals, Pharm D, Care Coach Nurses, Medical Assistants, Behavioral Health, Specialists, Quality Based Coders, Referral Coordinators… more
