- Monster (Quakertown, PA)
- …to:RN care managers, assistants, coordinators, utilization management staff, and director . Facilitates communication among all treatment team members. Manages length ... applicable state/federal regulatory notices as applicable ie.) Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), Bundle… more
- Monster (Salt Lake City, UT)
- …model with the University of Utah Health Plans. This position reports to the IOC Medical Director and will support the IOC patient population and the clinic team ... care physician (MD or DO) to be an integral part of an interdisciplinary team of medical ...a dedicated patient at the direction of the IOC's Medical Director * Perform history and physical examinations*… more
- Monster (New York, NY)
- …. Providing assistance in the administration of the non-union employee benefit plans ( Medical , Dental, Vision, Life & ADD, FSA, HSA, LTD, Transit, 401(k) etc.) . ... in the processing of short-term and long-term disability claims . Family and Medical leave (FMLA) administration . Paid Faily Medical Leave (PFL) administration… more
- Humana (Concord, NH)
- …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. ... The Behavioral Health Medical Director work assignments involve moderately complex...conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare… more
- Humana (Lansing, MI)
- …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests for ... services. The Medical Director work assignments involve moderately complex...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- CVS Health (Hartford, CT)
- …the US. **Responsibilities of this Medical Director role are related to Medicare Appeals:** * Direct daily work on part C appeals (both provider and ... * Provide direct support to appeal nurses and dedicated Medicare part D pharmacists; supervision and participation...in ABMS or AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance &… more
- Humana (Topeka, KS)
- **Become 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 be passionate… more
- Humana (Honolulu, HI)
- **Become 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...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Clinical Pharmacist Lead monitors drug development pipeline, and medical literature, ... diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and monitors… 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...physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the… more
- Houston Methodist (Katy, TX)
- …Multi-facility HB Epic AR management experience + Strong working knowledge of Facility Medicare ( Part A) guidelines. + Problem solving thought leader with proven ... areas of Revenue Cycle, to include but not limited to: medical coding, insurance billing, collections, patient account resolution, appeals/denials, customer service,… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following ... SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided… more
- Humana (San Juan, PR)
- …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… more
- Humana (Denver, CO)
- …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Raleigh, NC)
- **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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- CareOregon (Portland, OR)
- …is a federal contractor and must comply with all federal laws. Job Title Medical Director , Physician - Primary Care Requisition # 25065 Exemption Status Exempt ... costs and increase provider satisfaction. We are a proud part of the CareOregon family of health organizations. Our...Physicians, Physician Assistants and Nurse Practitioners Manager Title Sr Medical Director - Clinical Services HCP Department… more
- CenterWell (Anderson, SC)
- **Become a part of our caring community and help us...a positive and welcoming environment for all. The Associate Medical Director has similar job duties as ... medicine, continuity of care, health maintenance, and disease prevention. The Associate Medical Director serves as a health-care professional and capable of… more
- AdventHealth (Altamonte Springs, FL)
- …impacts of proposed operational decisions; and serves as subject matter resource for Medicare and Medicaid reimbursement matters. The Director is responsible for ... and State Medicaid programs, including changes affecting hospital reimbursement of Medicare bad debt, graduate medical education, disproportionate share hospital… more
- CareOregon (Portland, OR)
- …is a federal contractor and must comply with all federal laws. Job Title Medical Director - Hospice Requisition # 25073 Exemption Status Exempt Management Level ... 10% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This Hospice Medical Director role is primarily remote, with 60%… more
- CVS Health (Hartford, CT)
- …and behavioral health programs and services to its membership. Aetna is looking for a medical director to be part of a centralized team that supports ... related to precertification, concurrent review, and appeal request. The medical director is a work-at-home position located...Two (2) + years of experience in managed care ( Medicare and/or Medicaid) MD or DO; Board certification in… more
