- Humana (Baton Rouge, LA)
- …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 ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Albany, NY)
- …put health first** Humana's Marketing organization is seeking an Associate Director , Product Marketing to lead the go-to-market, positioning, and member-focused ... campaigns for our Medicaid lines of business. You will craft the product...on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA-Claims Hiring for One Year Term **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not ... this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr.… more
- Humana (Indianapolis, IN)
- …part of our caring community and help us put health first** The Indiana Medicaid Market CFO analyzes and forecasts financial, economic, and other data to provide ... accurate and timely information for strategic and operational decisions. The Director , Financial Planning & Analysis requires an in-depth understanding of how… more
- AbbVie (Mettawa, IL)
- … of Federal Contracting, Regional Director of Federal Accounts, and Director of Medicaid Contracting, including their respective AEs, to enhance account ... acquisition, contracting, retention, and pull-through performance across the DoD, VA, Medicaid , IHS and Kaiser channels. + Manage Channel Directors and Executives… more
- Prime Therapeutics (Providence, RI)
- …Come build the future of pharmacy with us. **Job Posting Title** Clinical Account Director - Remote **Job Description** The Clinical Account Director is ... As the primary point of contact for their designated BCBS clients, the director promotes and recommends Prime standard offerings to meet client requirements and… more
- Evolent (Phoenix, AZ)
- …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology to ... innovation, continuous improvement, and clinical excellence. + **This position is 100% Remote and can be completed from any state. Multiple opportunities for a… more
- Centene Corporation (Indianapolis, IN)
- …benefits including a fresh perspective on workplace flexibility. **We're Hiring: Remote Medical Directors** Centene Corporation is a leading provider of ... government-sponsored healthcare coverage, providing access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and… more
- Option Care Health (Madison, WI)
- …and brightest talent in healthcare. **Job Description Summary:** The Specialty Sales Director will develop and implement the Specialty business sales plan that ... responsibility. It will be imperative for the Specialty Sales Director to work closely with the other Sales Directors...Insurance, Medicare Part B & D, Fee for Service Medicaid , Managed Medicaid ) Due to state pay… more
- Stanford Health Care (Palo Alto, CA)
- …America) **This is a Stanford Health Care job.** **A Brief Overview** The Director of Reimbursement is a key leadership role within the Controller's Office, ... Department of Health Care Access and Information (HCAI) In addition, the Director of Reimbursement oversees the organization's responses to government audits and… more
- Molina Healthcare (Sterling Heights, MI)
- **Job Description** **Job Summary** The Director of IT (Telecom) provides strategic and operational leadership for the organization's enterprise communication, ... and secure interactions for members, providers, and employees. The director leads multidisciplinary teams responsible for communication engineering, AI innovation,… more
- Integra Partners (Troy, MI)
- …plan medical director + Experience with DMEPOS UM programs, MLTC, Medicaid , or Medicare Advantage + Experience chairing or participating in UM, Credentialing, or ... The Senior Medical Director (Senior MD) serves as the clinical and...consistent, accurate, and compliant application of criteria (LCDs, state Medicaid manuals, InterQual, internal policies, health plan guidelines, and… more
- Molina Healthcare (Spokane, WA)
- …**Preferred Experience** 10+ years experience Managed Care industry experience - Medicaid , Medicare, Marketplace. Network Management and Public Policy New Program ... implementation experience (inpatient/outpatient) Behavioral Health - Configuration, PCM, Providers Billing Guides To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support Integra's ... workflow timelines, clinical accuracy standards, and productivity expectations. The Medical Director ensures determinations are made in accordance with Medicare and … more
- Humana (Raleigh, NC)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... reference sources. Medical Directors will learn Medicare, Medicare Advantage, and Medicaid requirements and will understand how to operationalize this knowledge in… more
- Humana (Carson City, NV)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... conferences, and other reference sources. Medical Directors will learn Medicare, Medicaid , and Medicare Advantage requirements and will understand how to… more
- Humana (Harrisburg, PA)
- …Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical ... + Other activities as assigned by the managing Medical Director Travel: While this is a remote ...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Humana (Charleston, WV)
- …Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical ... + **Other activities as assigned by the managing Medical Director ** Travel: While this is a remote ...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- CVS Health (Springfield, IL)
- …CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board Certified Oncologist for this ... opportunity. This is a remote based from from home role. The Medical Affairs...Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director (Medical Affairs) will report into the Medical Affairs… more
- Humana (Jefferson City, MO)
- …of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex… more