- Humana (Montpelier, VT)
- **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...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Evolent (Montpelier, VT)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... improvement, and clinical excellence. + **This position is 100% Remote and can be completed from any state. Multiple...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… more
- Humana (Montpelier, VT)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... 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 (Montpelier, VT)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... 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 (Montpelier, VT)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Montpelier, VT)
- …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...internal teaching conferences, and other reference sources + Learns Medicaid requirements and understands how to operationalize this knowledge… more
- Humana (Montpelier, VT)
- **Become a part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals ... (Part D & B). The Medical director work assignments involve moderately complex... management review organization such as Medicare Advantage, managed Medicaid , or Commercial health insurance + Current and ongoing… more
- CenterWell (Montpelier, VT)
- …a part of our caring community and help us put health first** A ** Director of Authorizations & Eligibility** is a senior revenue cycle leader responsible for the ... payer approvals to protect revenue integrity and patient access. The Director partners closely with clinical leadership, operations, finance, compliance, and IT,… more
- Humana (Montpelier, VT)
- …our caring community and help us put health first** The Associate Director , Finance Data Management supports all aspects of configuration control, data management, ... and deficiency reporting. The Associate Director , Finance Data Management requires a solid understanding of...PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Humana (Montpelier, VT)
- …our caring community and help us put health first** The Associate Director , Technology Solution Implementation delivers new technological solutions to meet business ... a specified scope while aligned to enterprise objectives. The Associate Director , Technology Solution Implementation requires a solid understanding of how… more
- Humana (Montpelier, VT)
- …part of our caring community and help us put health first** The Director , Product Management for CenterWell Pharmacy Digital leads the strategic vision, development, ... business objectives, including accelerating growth in payor agnostic markets. Additionally, the Director will lead a team of Product Owners (POs) and Product… more
- Humana (Montpelier, VT)
- …part of our caring community and help us put health first** The Director , Business Systems Analysis leads the strategic advancement, optimization, and integration of ... initiatives that enhance provider experiences and streamline workflows. The Director requires deep expertise in business systems analysis, systems lifecycle… more
- Humana (Montpelier, VT)
- …of our caring community and help us put health first** The Associate Director of Cloud Infrastructure Operations is responsible for leading Humana's enterprise cloud ... at the intersection of operations, technology, and AI innovation. The Associate Director of Cloud Infrastructure Operations will drive the evolution of Humana's… more
- Humana (Montpelier, VT)
- …a part of our caring community and help us put health first** The Director of Finance Portfolio Management, Strategy, & Special Projects is a key leadership role ... focused on continuously improving consumer experiences Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may… more
- Humana (Montpelier, VT)
- …part of our caring community and help us put health first** The Associate Director of IT Disaster Recovery will lead DR operations and governance for all application ... PHI / HIPAA information Travel: While this is a remote position, occasional travel to Humana's offices for training...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Humana (Montpelier, VT)
- …accurate documentation specifying rational for approval, or for forwarding to the CMO/ Medical Director for further review. + Create reduction/denial letters ... (PA) requests and ensures that all benefits authorized meet medical necessity and other Medicare and/or Medicaid ...based on the CMO/ Medical Director 's review and applicable guidelines. +… more
- Humana (Montpelier, VT)
- …first** The Clinical Pharmacist Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes ... diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and monitors… more
- Humana (Montpelier, VT)
- …care or provider sector **Reporting Relationships** The role reports to a Director within the Strategy team, works collaboratively with leaders and members of ... and with senior leadership throughout the enterprise. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be… more
- Humana (Montpelier, VT)
- …including executives, HR, and external partners + Partners with the Associate Director to represent the program in executive forums, to define and provide ... to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be… more