- Humana (Columbus, OH)
- …**Additional Information** Typically reports to a Regional Vice President of Health Services, Lead , or Corporate Medical Director , depending on size of region or ... 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
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- …Centers for Medicare and Medicaid Services (CMS). As the Deputy Director , you will provide executive leadership, direction, and coordination for CMS' national ... purchasing medically necessary services under fee-for-service. Defines the scope of Medicare benefits and develops national fee-for-service payment policies as… more
- CVS Health (Hartford, CT)
- …Enterprise Economics, the Strategy team supporting Medicare , as well as the core Medicare Finance team. This Executive Director will also: + Be a strategic ... all the data for the monthly close, budgeting, and forecasting from the various Medicare product lines. + Lead the financial strategic and self-funded … more
- CVS Health (Hartford, CT)
- …strategic leadership and oversight for financial planning and analysis for a Medicare Local Market by managing a team of financial analysts, coordinating budgeting ... budget presentations for senior leadership, and day-to-day ad-hoc analyses + Medicare Experience. EducationBachelor or similar work experience This is a hybrid… more
- Elevance Health (Columbus, OH)
- ** Medicare Duals Management Director -Ohio** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 ... miles of our **Columbus, OH** Elevance Health PulsePoint location. The ** Medicare Duals Management Director ** is responsible for developing and ensuring the… more
- The Cigna Group (Columbus, OH)
- **Channel Marketing Director , Medicare Advantage - Hybrid** The Marketing Director will be responsible for leading the channel marketing team that supports ... the Cigna Medicare Advantage (MA) business. The MA business is a...coordinating across the enterprise to achieve results. The Marketing Director will lead a team that partners… more
- Somatus (Mclean, VA)
- …well-being + Community engagement opportunities + And more! The Director , Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation ... ensure program compliance with governing bodies' regulations, including the Center for Medicare and Medicaid Services. This role will partner with leadership to… more
- The Cigna Group (Morris Plains, NJ)
- The Director , Centene Account Management provides strategic, financial, clinical, relationship, and organizational leadership for the Medicare D and Exchange ... SLAS, key metrics, and client performance guarantees. + Identify gaps and lead special projects focused on improving operational effectiveness and implementing best… more
- UCLA Health (Los Angeles, CA)
- …do all this and more at UCLA Health. As an important member of our Medicare Advantage team, you will provide strategic oversight and leadership for our Member and ... the delivery of best-in-class service to new and existing members. You will lead , manage, coach, and develop teams to achieve high-performance standards in alignment… more
- The Cigna Group (Bloomfield, CT)
- …work with a team of professionals on setting and executing the vision for how our Medicare Growth team can lead Cigna to achieving its goals. Reporting to the ... **Summary** The Business Analytics Senior Advisor position within the Medicare Growth Analytics Team is an opportunity to provide...Growth Analytics Director , this position will coordinate with cross functional teams… more
- CVS Health (Santa Ana, CA)
- …business. CVS Health/Aetna is working to transform the way California Medicare beneficiaries experience health care - improving quality, emphasizing whole-person ... Manager to support the growth of our industry leading Medicare business. This is a highly collaborative role in...the United States and will report to the Sales Director for Southern California. This is a career position… more
- UCLA Health (Los Angeles, CA)
- …process and preparation of monthly financial statements. + Act as a liaison with the Lead Actuary, Director of Compliance, Director of Managed Care and ... Financial Officer of Faculty Practice Group, the Controller will lead the operations of the General Accounting department for...Director of Medicare Advantage Operations regarding accounting for risk contracts. Provide… more
- Corewell Health (Grand Rapids, MI)
- …of the member appeal and fair hearing review processes for all Medicare products to thoroughly investigate appeal requests, leveraging critical thinking skills, ... timely basis. Ensure CMS, decisions are properly implemented. Assist the Lead , Supervisor and/or Manager in coordinating activities and in the development/collection… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …procedures, and CMS guidance including coverage and benefit conditions included in Medicare laws, National Coverage Decisions (NCDs) and Local Coverage Decisions ... part of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as...and scope projects; keep project leads, senior consultants, and Director informed of key issues/ risks and meet deadlines… more
- CVS Health (Sacramento, CA)
- …This is a remote position and may sit anywhere within the US The Lead Director works with VP, CMO Aetna Medicare and the AVP, Deputy CMO, Medicare ... level buy-in, implementing change, and generating demonstrable impact. In addition, Lead Director will facilitate efforts to develop clinical strategies… more
- CVS Health (Downers Grove, IL)
- …committed to increasing access, lowering costs and improving quality of care. In this Director level role you will have the opportunity to have a significant impact ... the CVS Health family of companies. In this non-supervisory Director level position, you will assume a highly visible...will assume a highly visible role and responsibility to lead discussions and engage in strategic negotiations on high-value… more
- CVS Health (Scottsdale, AZ)
- …CVS Health has an exciting opportunity to join our PBM Finance team as Director , Financial Performance Reporting. This is a newly created role that will lead ... enhanced insights, improve operational efficiency, and provide outstanding customer service. The Director will be a proven leader who has built and managed teams… more
- CVS Health (Hartford, CT)
- …care more personal, convenient and affordable. Job Purpose and Summary: The LTSS/SAI National Senior Medical Director , reporting to a Regional CMO of Medicaid, ... determined by the plan leadership for NCQA and audits.* Lead the Medicaid markets national SAI ideation,...of health care industry. Preferred industry depth in a Medicare and/or Medicaid line of business* Strategic thinking with… more
- Humana (Columbus, OH)
- …**Additional Information** Typically reports to a Regional Vice President of Health Services, Lead , or Corporate Medical Director , depending on size of region or ... 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 … more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …to ensure timeliness, accuracy and reliability of UM and Appeals reviews\. + Lead and serve on various committees in order to accomplish medical utilization, cost ... + Ability to interpret and explain complex government policies + Knowledge of Medicare programs **Job Specific Requirements:** Medicare experience is a plus\.… more