- Novo Nordisk Inc. (WA)
- …health outcomes. Are you ready to realize your potential? The Position The Senior Director works on complex issues that require an in-depth knowledge of the company ... may include, but are not limited to: NN Foundation, Quality, Medicare , Medicaid, Transparency, Adherence, Importation, Reference Pricing, Pricing / Price Increases,… more
- Eisai, Inc (Miami, FL)
- …Patient Services/Market Access. Working closely with and reporting to the Associate Director , Access and Reimbursement, the ARM, will be the functional lead for ... the US healthcare system across one or more major payer segments ( Medicare , Medicaid, Federal, and Commercial).Experience working with medical and pharmacy benefits,… more
- CVS Health (Hartford, CT)
- …remote 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 ... and Utilization Management Strategy support * Collaborative work with Medicare Quality and Compliance on an ongoing basis *...an ongoing basis * Develop subject matter expertise on Medicare policy for the enterprise * Provide ongoing education… more
- Humana (Concord, NH)
- …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 to complex issues...of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and… more
- Molina Healthcare (Columbus, OH)
- **Job Description** **Job Summary** Leads and directs Molina Medicare segment leaders who are responsible for the development and administration of Medicare ... markets, including D-SNP market performance management. + Function as Medicare subject matter expert and point of contact for...and quality levels exist in line with Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements.… more
- Humana (Topeka, KS)
- …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 scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Humana (Honolulu, HI)
- …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 scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Lansing, MI)
- …diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and monitors ... for our Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of… more
- Molina Healthcare (Madison, WI)
- …Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + Previous leadership ... License without restrictions (free of sanctions from Medicaid or Medicare ) **PREFERRED EDUCATION:** Master's in Business Administration, Public Health, Healthcare… more
- Molina Healthcare (San Antonio, TX)
- …**Job Summary** Responsible for the Management of internal business projects and programs involving department or cross-functional teams of subject matter experts, ... delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs, and monitors… more
- Humana (Carson City, NV)
- …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
- Centers Plan for Healthy Living (Staten Island, NY)
- … Medicare or Sales experience SCOPE INFORMATION # Direct Reports: Director of Medicare Marketing Physical Requirements: The physical requirements described ... they need for healthy living. JOB SUMMARY : The Medicare MAP Advisor- Will promote and sale MAP and... MAP Advisor- Will promote and sale MAP and Medicare Line of Business, maintains relationships, services our existing… more
- CVS Health (Springfield, IL)
- … Director UM decisions. If specifically assigned to one business segment (ie, Medicare clients), each director will become sufficiently skilled in various UM ... CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director (Medical Affairs). This is a remote based, work from home opportunity. The… more
- Molina Healthcare (Scottsdale, AZ)
- …by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the standards and controls that ... related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with CMS CTM… more
- Centene Corporation (Raleigh, NC)
- …management of department overseeing compliance with regulations and laws related to Medicare line of business, which includes implementation of elements of an ... process for overseeing compliance with regulations and laws related to Medicare requirements + Provides guidance to various business departments regarding compliance… more
- UTMB Health (Galveston, TX)
- …and for directing staff in preparation of these reports. + Supports Director , Finance-Government Reimbursement in preparing annual Medicare , Medicaid and TDCJ ... to implement appropriate processes and procedures to ensure compliance with Medicare and Medicaid regulations. + Supports Director , Finance-Government… more
- AdventHealth (Hendersonville, NC)
- …compliance with external accreditation standards, state and federal laws and Medicare conditions of Participation. The Director ensures administrative interface ... shops, art galleries and unique restaurants The role you'll contribute: The Director manages the functions required to support the market-wide medical staff… more
- Aveanna Healthcare (Tuscumbia, AL)
- …the client's physician, therapists or other care givers. + Provide input to the Medicare Director regarding the need for formulation or modification of agency ... year medical social work experience + Valid CPR As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in… more
- Aveanna Healthcare (Winchester, VA)
- …the client's physician, therapists or other care givers. + Provide input to the Medicare Director regarding the need for formulation or modification of agency ... + Master's degree in Social Work preferred As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in… more
- Aveanna Healthcare (Griffin, GA)
- …the client's physician, therapists or other care givers. + Provide input to the Medicare Director regarding the need for formulation or modification of agency ... year medical social work experience + Valid CPR As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in… more
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