- Humana (Concord, NH)
- …topics to the clinical operations team and healthcare organization. The Medical Director 's work includes computer based review of moderately complex to ... and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health...conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare… more
- Humana (Carson City, NV)
- **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
- CVS Health (Hartford, CT)
- …based (work at home) based anywhere in the US. Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part C ... of experience in a Health Care Delivery System eg, Clinical Practice or Health Care Industry * Medical...in ABMS or AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance &… 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...represents Humana at Administrative Law Judge hearings; exercises independent clinical judgment and decision making on complex issues regarding… more
- Humana (Honolulu, HI)
- …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...+ Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry… more
- Molina Healthcare (Madison, WI)
- …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
- Humana (Lansing, MI)
- …The Clinical Pharmacist Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes ... of diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and… more
- SUNY Upstate Medical University (Syracuse, NY)
- …and Practice Operations and collaborate closely with Primary Care clinic Medical Directors and Nurse Leadership. Duties/Responsibilities: Identify Medicare ... Job Summary: Position Summary: Upstate University Medical Associates at Syracuse Inc. (UUMAS) is seeking...accurate coding and documentation to support quality initiatives and Medicare compliance. Work closely with clinical teams… more
- Centene Corporation (Queens, NY)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... will lead and support the expansion and optimization of Medicare -focused VBP arrangements across New York. This role is...position will be responsible for working with the VBP Director , other VBP Managers, and Analysts, as well as… more
- Commonwealth Care Alliance (Boston, MA)
- …at this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding ... to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for claims, settlement, claims auditing… more
- Community Health Systems (La Follette, TN)
- …Information Management, or related field preferred + 1-2 years of experience in Medicare billing, medical claims processing, or hospital revenue cycle operations ... **Job Summary** The Medicare Billing Specialist is responsible for performing timely...documentation review. This role collaborates with revenue cycle teams, clinical departments, and external payers to ensure claims are… more
- Gentiva (Fairfax, VA)
- …leadership, Director of Clinical Services jobs, Hospice nurse director , Hospice compliance RN, and Medicare Hospice regulations ReqID: 2025-127547 ... Excellence. Deliver Compassionate Care. Transform Hospice Services.** We are seeking a RN Director of Clinical Services to join our team. Reporting to the… more
- Genesis Healthcare (Carmichael, CA)
- …therapists, consideration of clinical requirements, and recommendations from the Clinical Director . 11. Administers financial controls of revenue and ... place for you. **Why Powerback?** + **Benefits:** We offer Medical , Dental, and Vision plans to Full-Time team members....with licensed therapists, the Clinical Operations Area Director , and the Clinical Director .… more
- Genesis Healthcare (Lenexa, KS)
- …treating therapists, consideration of clinical requirements and recommendations from the Clinical Director . 8. Continues direct patient care. 9. Assists the ... place for you. **Why Powerback?** + **Benefits:** We offer Medical , Dental, and Vision plans to Full-Time and Part-Time...opportunity for clinical growth in collaboration with Director of Rehab, Clinical Director … more
- Genesis Healthcare (Franconia, NH)
- …therapists, consideration of clinical requirements, and recommendations from the Clinical Director . 12. Administers financial controls of revenue and ... place for you. **Why Powerback?** + **Benefits:** We offer Medical , Dental, and Vision plans to Full-Time team members....with licensed therapists, the Clinical Operations Area Director and the Clinical Director .… 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, ... HB Epic AR management experience + Strong working knowledge of Facility Medicare (Part A) guidelines. + Problem solving thought leader with proven execution… more
- Aveanna Healthcare (Clark, NJ)
- Clinical Director - Home Care - RN ApplyRefer a FriendBack Job Details Requisition #: 207908 Location: Clark, NJ 07066 Category: Nursing Salary: $85,000.00 - ... you when you come to Aveanna. Position Overview The Clinical Director is responsible and accountable for...or without notice. Vaccination Requirements As an employer accepting Medicare and Medicaid funds, employees must comply with all… more
- Aveanna Healthcare (Tampa, FL)
- RN Clinical Director ApplyRefer a FriendBack Job Details Requisition #: 204579 Location: Tampa, FL 33607 Category: Nursing Salary: $78,000.00 - $82,000.00 per ... year Position Details Position: Clinical Director (RN) ( Director of...children, adolescents, and/or adults. Note: As an employer receiving Medicare and Medicaid funds, Aveanna employees must comply with… more
- Aveanna Healthcare (Alton, IL)
- Clinical Director - RN ApplyRefer a FriendBack Job Details Requisition #: 207824 Location: Alton, IL 62002 Category: Nursing Salary: $80,000.00 - $90,000.00 per ... while making a meaningful difference every day. What You'll Do As theClinical Director , you'll be accountable for managing all clinical operations within your… more
- Care Initiatives (West Des Moines, IA)
- Care Initiatives is seeking a Director of Clinical Reimbursement. As the largest single operator of quality nursing homes in Iowa, Care Initiatives has over ... support at every stage of the healthcare journey. The Director of Clinical Reimbursement is responsible for...care and skilled nursing. + Extensive knowledge of MDS/RAI, Medicare reimbursement, PDPM systems, compliance and Medicaid Clinical… more