• Corporate Medical Director

    Humana (Santa Fe, NM)
    …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 (09/05/25)
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  • Medical Director ( Medicare )

    Molina Healthcare (Santa Fe, NM)
    …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 (09/12/25)
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  • Medical Director - Medicare

    Humana (Santa Fe, NM)
    …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 (10/02/25)
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  • Senior Medical Director

    Molina Healthcare (Santa Fe, 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
    Molina Healthcare (09/12/25)
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  • Medical Director - OneHome

    Humana (Santa Fe, NM)
    …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 ... SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided… more
    Humana (09/27/25)
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  • Finance Director ( Medicare

    Molina Healthcare (Santa Fe, NM)
    **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
    Molina Healthcare (10/11/25)
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  • Medical Director - Gulf South

    Humana (Santa Fe, NM)
    **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 (10/03/25)
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  • Medical Director - Mid West Region

    Humana (Santa Fe, NM)
    **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… more
    Humana (09/16/25)
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  • Medical Director -Payment Integrity

    Humana (Santa Fe, NM)
    **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 (09/26/25)
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  • Medical Director - Northeast Region

    Humana (Santa Fe, NM)
    **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
    Humana (07/25/25)
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  • National Medical Director

    CenterWell (Santa Fe, NM)
    …and high-risk Medicare patients within a full-risk, value-based framework. The Medical Director collaborates in a dyad partnership with the Strategy ... a part of our caring community and help us put health first** The National Medical Director for Home-Based Care Programs is a key clinical leadership position… more
    CenterWell (10/02/25)
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  • Field Medical Director , Cardiology

    Evolent (Santa Fe, NM)
    …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. ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
    Evolent (10/01/25)
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  • …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
  • Field Medical Director , Oncology

    Evolent (Santa Fe, NM)
    …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 ... timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
    Evolent (08/19/25)
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  • Field Medical Director , (Orthopedic…

    Evolent (Santa Fe, NM)
    …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 ... timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
    Evolent (08/29/25)
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  • Medical Director , Behavioral Health…

    Molina Healthcare (Santa Fe, NM)
    …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 (09/13/25)
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  • Medical Director , Behavioral Health…

    Molina Healthcare (Santa Fe, NM)
    …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 (10/03/25)
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  • Director , Appeals & Grievances (Remote)

    Molina Healthcare (Santa Fe, NM)
    …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
    Molina Healthcare (09/26/25)
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  • Director - Strategy & Analysis and Contract…

    Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
    The Director , Strategy & Analysis and Contract Operations is responsible for directing and conducting pricing analysis of government policy and evaluating pricing ... contracting and in-depth understanding of GPO/PBM/National and Regional Health Plan business models, Medicare Part D, Medicare Part B, 340B, and the changing… more
    Otsuka America Pharmaceutical Inc. (10/14/25)
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  • Associate Director Informatics

    CenterWell (Santa Fe, NM)
    …, Informatics** will be responsible for supporting Patient Safety analytics on the Medicare population. The Associate Director is expected to perform and present ... of our caring community and help us put health first** The Associate Director , Informatics coordinates with other analytics, IT and business areas across the… more
    CenterWell (10/09/25)
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