- Centene Corporation (CA)
- …to providers that would improve utilization and health care quality. * Reviews claims involving complex , controversial, or unusual or new services in order ... Directors Centene Corporation is a leading provider of government-sponsored healthcare coverage, providing access to affordable, high-quality services to Medicaid… more
- NORC (Washington, DC)
- …makers can trust. **RESPONSIBILITIES:** + Serving as program area and project director with significant responsibilities on complex scientific and/or technical ... preferred) with demonstrated experience leading analyses with large administrative healthcare datasets (Medicare, Medicaid, and All-Payer Claims Databases)… more
- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance Position Summary: The Director of Provider Relations leads the strategic vision and operational execution of provider ... role is responsible for cultivating high-impact relationships with key healthcare providers, optimizing network performance, and ensuring compliance with regulatory… more
- Stanford Health Care (Palo Alto, CA)
- …(10-15) years of compliance and privacy program management responsibility in a complex , multi-organizational healthcare environment + At least seven to ten ... and Privacy Officer in the Office of Compliance and Privacy, the Executive Director - Compliance and Privacy is responsible for implementing and managing the… more
- Lyric (Newtown Square, PA)
- Lyric is an AI-first, platform-based healthcare technology company, committed to simplifying the business of care by preventing inaccurate payments and reducing ... overall waste in the healthcare ecosystem, enabling more efficient use of resources to...lyric.ai/careers and drive innovation with #YouToThePowerOfAI. The Senior Medical Director is a senior clinical leader who will represent… more
- BeOne Medicines (San Mateo, CA)
- …Understand the current and emerging AI and machine learning techniques to analyze complex datasets related to market access, healthcare economics, and patient ... **General Description:** The Director , Strategic Evidence, will possess an understanding of...customers, and / or past direct work experience at claims , EMR / EHR, real world data vendors, IDNs,… more
- BeOne Medicines (Emeryville, CA)
- …feasibility tools and roadmaps. This position is responsible for transforming complex data into actionable insights that drive strategic feasibility decisions, ... competing trials, recent or upcoming approvals, prescribing data, insurance claims data, diversity, and recruitment capabilities. This includes intelligence… more
- Lundbeck (Deerfield, IL)
- …Do you want to join a team where the mission is meaningful, the challenges are complex , and you can directly see the results of your hard work? Lundbeck is a global ... of growth! **Summary:** The Manager, Field Compliance will support the Director , Field Compliance and Investigations with driving and implementing all elements… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …experience in healthcare , including familiarity with hospital systems, diverse healthcare data sets ( claims , EHR, clinical data, structured and unstructured ... half a million times each year. From primary to complex critical care, more than 350 programs and services...Analyst II, under the direction and supervision of the Director of Analytics, will play a hands-on role in… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …years of experience in healthcare , including familiarity with hospital systems, healthcare data sets ( claims , EHR, clinical data, structured and unstructured ... half a million times each year. From primary to complex critical care, more than 350 programs and services...Analyst III, under the direction and supervision of the Director of Analytics, will play a hands-on role in… more
- AIG (Jersey City, NJ)
- Claims Complex Director - Healthcare Professional Liability (HPL) Join us as a Claims Complex Director to take on key responsibilities within ... an impact + This position will ensure high quality claims handling within the Healthcare Professional Liability...+ 7+ years of medical malpractice / professional liability complex claims and/or complex litigation… more
- Humana (Lansing, MI)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- UNC Health Care (Chapel Hill, NC)
- …health and well-being of the unique communities we serve. **Summary** : Reporting to the Director of Claims & Litigation, the Claims and Litigation Manager ... and the monitoring of incidents that develop into claims against healthcare providers and staff of...claims information in the internal database. Assists the Director in other projects related to claims … more
- Commonwealth Care Alliance (Boston, MA)
- …billing-related certifications **Required Experience (must have):** + 3+ years in healthcare claims processing, provider reimbursement, or payment integrity. + ... states will not be considered at this time._** **Position Summary:** Reporting to the Director , Claims Operations and Quality Assurance, the Claims Sr.… more
- Prime Healthcare (Farmers Branch, TX)
- …trends and identify opportunities for process improvement and reimbursement optimization. Complex Claims Management:identifies, trends, and owns portfolios of ... Outsourcing program across Revenue Cycle Management for all Prime Healthcare . The Corporate Director is responsible for...complex claims , including Third party claims , TDRG, Zero… more
- Huron Consulting Group (Chicago, IL)
- …Work Authorization required **PREFERRED QUALIFICATIONS:** + Experience with comprehensive healthcare data sets ( claims , payroll, financial performance, clinical, ... and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling… more
- The Cigna Group (St. Louis, MO)
- **WORK LOCATION: St. Louis, MO** The **Provider Contracting Director ** serves as an integral member of the Provider Contracting Team and reports to the Provider ... for a local given territory. **DUTIES AND RESPONSIBILITIES** + Manages complex contracting and negotiations for fee for service and value-based reimbursements… more
- Tenet Healthcare (Commerce Township, MI)
- Director of Revenue Analysis - 2506003876 Description : Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your ... DMC Huron Valley-Sinai Hospital , we're seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient… more
- The Cigna Group (Cleveland, OH)
- …LOCATION: Must reside in the Cleveland or Independence, OH area.** The ** Director ** **,** **Provider Contracting Network Management** serves as an integral member of ... for a local given territory. **DUTIES AND RESPONSIBILITIES** + Manages complex contracting and negotiations for fee for service and value-based reimbursements… more
- Centene Corporation (Tallahassee, FL)
- …L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT._** **Position Purpose:** The Senior Director , Healthcare Analytics leads analytic service delivery by aligning strategic ... of tools and capabilities and appropriate deployment of supporting analytic teams. The director serves in a leadership function spanning the needs of multiple health… more
