- Elevance Health (Walnut Creek, CA)
- ** Medical Director - Medicare and Medicaid ** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... and skill development. Candidates must live in California. The ** Medical Director ** will be responsible for utilization...will be responsible for utilization review case management for Medicare and Medicaid in the California market… more
- ChenMed (Metairie, LA)
- …years' previous experience as Medical Director or equivalent with a Medicare or Medicaid patient population + Board eligibility is required. + Board ... preferred. + Preferred to be an existing high performing PCP partner and/or Medical Director within the ChenMed core model, with a proven ability to manage a… more
- Commonwealth Care Alliance (Boston, MA)
- …have):** + 7+ years of Healthcare experience, specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical ... operations, health care reimbursement, public health care programs and reimbursement methodologies ( Medicaid and Medicare ) + Medical Coding, Compliance,… more
- OhioHealth (Columbus, OH)
- …**Job Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This ... position will be responsible for ensuring the appropriate governmental ( Medicare and Medicaid ) reimbursement is received for OhioHealth. * This position is… more
- Fallon Health (Worcester, MA)
- …responsible for the presentation of the member appeal to the FH Medical Director , Center for Medicare / Medicaid Services, contracted reviewer, as well as ... staff. Work with Team Leaders, Department Managers, Department Chairs and/or Medical Director to resolve member complaints; formulate improvement measures… more
- Aston Carter (Honolulu, HI)
- …of enrollment information and demographic changes (including coordination of benefit, Medicare Secondary Payer and Medicare Late Enrollment Penalty information), ... for all lines of business (including all post-application activities for Medicare , QUEST newborn follow-up and disability disenrollment tracking), TPL follow-up for… more
- Humana (Topeka, KS)
- …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… more
- Humana (Springfield, IL)
- …development for our Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Illinois Medicare - Medicaid health plan. The individual leverages a broad ... efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large.… more
- Humana (Baton Rouge, LA)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... health first** Humana Healthy Horizons is a seeking a Senior Project Manager ( Medicaid Network Implementation) who is accountable for working with the Director ,… more
- Centene Corporation (Dover, DE)
- …Supports (LTSS) and Medicare - Medicaid Duals populations. Additionally, the Medical Director will collaborate with other key stakeholders to provide ... Director to manage and optimize LTSS and Medicare - Medicaid Duals program operations, focusing on improving...LTSS Only:** A full-time Long Term Services and Supports Medical Officer/ Medical Director (LTSS CMO)… more
- Humana (Dover, DE)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... caring community and help us put health first** The Medical Director relies on medical ...a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health… more
- RWJBarnabas Health (Oceanport, NJ)
- … will serve as a key resource to department leadership for providing Medicare and Medicaid reimbursement support and implementing government payment strategies ... Health hospitals. This includes planning, preparing and reviewing of the annual Medicare / Medicaid cost reports filings. In partnership with the Vice President… more
- State of Colorado (Denver, CO)
- …Department of Health Care Policy and Financing (Department), including the Colorado Medical Assistance Program ( Medicaid ) and the Colorado Children's Basic ... (BME), Regulatory Agencies, Office of the Inspector General (OIG), the Centers for Medicare and Medicaid (CMS), US Attorney's Office, United States Department of… more
- Humana (Concord, NH)
- …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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical … more
- Humana (Dover, DE)
- …clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicaid , and ... caring community and help us put health first** The Medical Director actively uses their medical...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Charleston, WV)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... caring community and help us put health first** The Medical Director actively uses their medical...a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health… more
- Beth Israel Lahey Health (Charlestown, MA)
- …and AVP, the Director will develop long- and short- term Medicare , Medicaid , and other government reimbursement revenue strategies, oversee preparation and ... job, you're making a difference in people's lives.** The Director , Revenue Finance and Reimbursement, will be a core...both government and commercial payment systems; and, (4) Provide Medicare , Medicaid , and payment system expertise in… more
- Integra Partners (Troy, MI)
- …of Durable Medical Equipment (DME) requests in alignment with Medicare / Medicaid guidelines, state-specific, and health plan criteria. + Function within ... + Integra Partners is seeking a full-time Utilization Review Medical Director to support our Utilization Management...past OIG or state sanctions; eligible for participation in Medicare , Medicaid , and other federally funded programs.… more
- CVS Health (Springfield, IL)
- …and/or medical necessity appeals for commercial clients, governmental ( Medicare / Medicaid ) programs and individual client requested coverage determinations or ... Fortune 6 company, has an outstanding opportunity for a Medical Director ( Medical Affairs). This...decisions. If specifically assigned to one business segment (ie, Medicare clients), each director will become sufficiently… more
- Humana (Pierre, SD)
- …caring community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid builds strategies for ... across the function or segment. The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid ...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more