- Humana (Richmond, VA)
- …Humana Healthy Horizons in Virginia is seeking a Director , Care Management of Long-Term Services and Supports ( LTSS ) who will lead teams of nurses ... and behavior health professionals responsible for care management . The Director , Care Management ( LTSS ) requires an in-depth understanding of how… more
- Humana (Charleston, WV)
- …and help us put health first** Humana Healthy Horizons in Virginia is seeking an Associate Director , Care Management ( LTSS /ABD) who will lead teams of ... providing integrated services for the clinical teams. The Associate Director , Care Management requires a...to identify the clinical tools and systems to support LTSS Care Management activities. **Use… more
- CVS Health (Hartford, CT)
- …national Medicaid LTSS line of business including but not limited to UM, Quality, care management , and network growth as listed below.. * Support the RFP and ... products* Assure compliance with State contracted mandates for cost, quality, and care management initiatives.* Provide clinical expertise and guidance in the… more
- Humana (Annapolis, MD)
- …and help us put health first** Humana Healthy Horizons in Virginia is seeking a Manager, Care Management ( LTSS -ABD) who will lead a team of nurses and ... ( LTSS ) Waiver Services, in hospice and/or in nursing facilities. They will lead LTSS -ABD care management operations and staff to ensure timely and… more
- AmeriHealth Caritas (Newark, DE)
- …of clinical practice. + Experience in Utilization Management as a Medical Director within a managed care organization desired. + Experience with community ... **Medical Director , LTSS ** Location: Newark, DE Primary...**Responsibilities:** Provides organizational leadership in the operational areas of care management , utilization review, appeals, quality improvement… more
- Centene Corporation (Harrisburg, PA)
- …fresh perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management , quality ... work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a… more
- State of Massachusetts (Boston, MA)
- …care programs, Senior Care Options (SCO) and the Program of All Inclusive Care for the Elderly (PACE). The Deputy Director Personal Care Attendant ... appropriately implement program and ensure access and quality of care . * Ensure program management and service...driving system change. * Knowledge of the Massachusetts health care industry and market dynamics related to LTSS… more
- Humana (Columbus, OH)
- …Preferred Qualifications: + Medicaid managed care experience working with LTSS program population. + Utilization management experience in a medical ... resource for the duals and long-term services and support ( LTSS ) program as well as its providers with a...of business. The Medical Director conducts Utilization Management of the care received by members… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Senior Director , Third Party Compliance Oversight reports directly to the SVP, Corporate Compliance & Ethics and Risk ... and leads the Third-Party Compliance Oversight department for Commonwealth Care Alliance (CCA). This position effectively leads our Third-Party Compliance… more
- CVS Health (Hartford, CT)
- …of our members' health care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing ... Executive Director of Duals and other Duals Care Management leadership to collaborate across the... LTSS highly preferred * 3-5 year of Care Management experience * Ability to work… more
- Commonwealth Care Alliance (Boston, MA)
- …insurance and managed care products and services, including Medicare, Medicaid, MMP, LTSS , SNP, Duals, CHIP, and behavioral health, as well as the associated and ... **Why This Role is Important to Us:** **Position Summary:** The Director , Quality & Control Assurance reports to the VP of Quality & Control Assurance is responsible… more
- Baystate Health (Springfield, MA)
- …Management , Complex Case Management , Wellness/HEDIS STARs and Transitions of Care ). The Director will oversee the strategic direction and clinical ... success, direct supervision of the BeHealthy ACO medicaid ambulatory care management teams, and medical management...entities to align strategies and tactics. Along with the Director of Quality and Medical Management , he/she… more
- CVS Health (Columbus, OH)
- …interventions.* Work with medical director teams focusing on inpatient care management , clinical coverage review, member appeals clinical review, medical ... health populations to optimize risk adjustment, clinical quality, and care management * Actively participate in meetings and...specialty). * 3+ years of experience in the managed care industry. * 1 year LTSS /MLTSS experience.… more
- Liberty Healthcare Corporation (Fayetteville, TN)
- …growth, Liberty Healthcare seeks qualified candidates for a potential new Quality Director position. This is a key leadership role with a statewide program ... Screening and Resident Review (PASRR) processes + Medical or Level of Care (LOC) eligibility assessment and appeals for Long-Term Services and Supports (… more
- Liberty Healthcare Corporation (Fayetteville, TN)
- …growth, Liberty Healthcare seeks qualified candidates for a potential new Clinical Director position. This is a key leadership role with a statewide program ... Screening and Resident Review (PASRR) processes + Medical or Level of Care (LOC) eligibility assessment and appeals for Long-Term Services and Supports (… more
- Humana (Bedford, IN)
- …and/or in-person to establish goals and priorities, evaluate resources, develop plan of care and identify LTSS providers and community partnerships to provide a ... Assisting members in maintaining Medicaid eligibility + Collaborate with Medical Director /Geriatrician/ Care Coordinator as deemed necessary to ensure cohesive,… more
- Highmark Health (Dover, DE)
- …providers for care -coordination. + Participate in rounds with the Medical Director . + Review documentation and processes for consistent practice, and to identify ... use of resources for members enrolled in DSHP Plus LTSS . Provides direct oversight to Case Managers, meets all...the day to day activities as needed. + Ensure care is medically appropriate, high quality, and cost effective.… more
- Greater Lynn Senior Services (Lynn, MA)
- …Experience * Three (3) years' experience in community nursing *Experience providing care management in a health and/or human services organization *Previous ... referral bonuses of up to $1,000 Position Overview: The LTSS Program Clinical Care Nurse will complete...for Care Transitions support.. The NRLP Clinical Care Nurse will support the Program Director … more
- Molina Healthcare (Seattle, WA)
- …Bilingual, Spanish, Spanish Speaking, MCO, Medicare Advantage, Waiver, healthcare, Health Care , LTSS , Salesforce, Data, Analysis, Reporting, Enrollment, Enroll, ... 50-75% travel. + Healthcare experience of some kind. Managed Care is a big plus! + Sales/Marketing experience and/or...(You will flex other days off). + Previous leadership/ management experience. + Proficient in Excel for reporting purposes.… more
- Elevance Health (Columbus, OH)
- …Responsibilities** + Manage the health plan(s) P&L to include revenue, cost management /Cost of Care , SG&A, and forward-looking product growth opportunities. + ... may be available. **Summary** Responsible for the fiscal, operational, and regulatory management for both large and complex Medicare Health plans in Ohio. The… more