- 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
- CVS Health (Columbus, OH)
- …implementation and milestone tracking for business plans as Part of the Medicare benefit and product cycle. Directs the strategic development and implementation of ... large product initiatives, including new products and product enhancements for Medicare formularies, UM and clinical tools for Medicare PDP, MAPD and employer… more
- CVS Health (Hartford, CT)
- …to make health care more personal, convenient and affordable. **Position Summary** The Lead Director , Project Program Management will lead a cross-functional ... team focused on delivering large, complex strategic initiatives for the Medicare Organization. In a matrix management capacity, you will provide leadership and… 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 ... community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. The Behavioral… more
- CVS Health (Woonsocket, RI)
- …to deliver unparalleled results. We are seeking an Executive Director to lead the newly formed **Group Medicare Performance Optimization** team. This leader ... prepare and report on ongoing business performance results, activities and initiatives + Lead the Group Medicare governance forum to communicate results, elevate… more
- Elevance Health (Atlanta, GA)
- ** Director Medicare Pharmacy Management** **Location: This is a hybrid position. Candidates must live within 50 miles of an Elevance Health location.** **Build ... Make an extraordinary impact.** Responsible for oversight and implementation of the Medicare Pharmacy Benefit and vendor(s) that administer the Medicare pharmacy… more
- UCLA Health (Los Angeles, CA)
- Description As the Assistant Director of Medicare Advantage Audit and Fraud Compliance, you'll play a crucial role in safeguarding our health plan resources and ... to detect and address non-compliance, Fraud, Waste, and Abuse (FWA) within our Medicare Advantage and Prescription Drug programs. Leading a team of managers, you'll… more
- Somatus (Mclean, VA)
- …+ Community engagement opportunities + And more! The Sr. 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
- Travelers Insurance Company (Columbus, OH)
- …strategies for addressing and resolving various types of debt, including Medicare , to deliver positive financial outcomes. This role requires leveraging economic ... and forums. **What Will You Do?** + Claim Strategy: + For specific national line of business initiatives develops and directs strategies and business plans for… more
- GEHA (Lee's Summit, MO)
- …meeting contractual and regulatory requirements. + Work in conjunction with the Vice President and Director of Pharmacy to align Medicare Part D / EGWP lines of ... personalized customer experience, sustained by a nimble and efficient organization. The Medicare Part D Performance Management Specialist will report to the … more
- Prime Therapeutics (Columbus, OH)
- …and drives every decision we make. **Job Posting Title** Principal Actuary - Medicare Part D - Remote **Job Description** The Principal Actuary is responsible for ... for all lines of business. This position will also lead complex projects that are highly visible to executives...healthcare organization or PBM + Previous experience pricing Commercial, Medicare or Medicaid lines of businesses + 5 years… more
- The Cigna Group (Nashville, TN)
- …Senior Manager will work with the Provider Data Quality & Accuracy (PDQA) Director to establish the framework and policies to drive improvements in the provider ... goals and metrics, as defined by business and regulatory requirements. They will lead a team of data stewards responsible for maintaining data lineage, business… more
- The Cigna Group (Atlanta, GA)
- …& Solutions). Reporting to the Network Operations Senior Manager or Director , this individual ensures the effective performance management of the provider ... within the market. Often this includes multi-site health systems and national primary care clinic partners. The Provider Performance Enablement Advisor's… more
- Trinity Health (Atlanta, GA)
- …follow up on overdue accounts and rejected claims. + Notify the Department Director or Manager as necessary regarding billing and claim processing. + Facilitate ... and resolve payment discrepancies. + Experience in physician offices with Medicare /Medicaid exposure is a plus. **Position Highlights and Benefits:** + Day-1… more
- The Cigna Group (Maitland, FL)
- …and Network Development & Solutions). Reporting to the Provider Performance Director , the Provider Performance Manager ensures the effective management of the ... + All market team members contribute to the growth and profitability of the Medicare Advantage (MA) business in their market in the following aspects: + Growing the… 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 ... 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
- CVS Health (Chicago, IL)
- …reports on these issues. **A Brief Overview** The primary responsibility of this director role will be leading Actuarial market support for the Central region's ... Medicaid contracts (IL, KS, MI, OK). Within this role, you'll: + Lead /manage Plan and analytical support to achieve operating plan goals. + Influence business… more
- CVS Health (Blue Bell, PA)
- …reasonable actuarial projections. **A Brief Overview** The primary focus of this director role will be leading actuarial support for the financial forecast modeling ... trend normalization and projection. **Fundamental Components** Primary Role (70% time): + Lead budget and forecast storytelling for the Medicaid business. + Oversee… 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 ... 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
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal… more