- Humana (Frankfort, KY)
- **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
- Humana (Frankfort, KY)
- …to adapt and the courage to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The Medical ... caring community and help us put health first** The Medical Director relies on medical ...Medical Directors will learn North Central region state Medicaid requirements (currently VA, KY, OH, IN, WI) and… more
- Humana (Frankfort, KY)
- …party reporting including notification, collection, analyze, storage, and distribution. + Team representative and presenter for various Medicaid committee ... caring community and help us put health first** The Associate Director , Procurement generates and implements efficient sourcing and category management strategies.… more
- Humana (Frankfort, KY)
- **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 (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Humana (Frankfort, KY)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture + Knowledge and experience with national guidelines… more
- Humana (Frankfort, KY)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture** + **Knowledge and experience with national guidelines… more
- CVS Health (Frankfort, KY)
- …and guidance to the health plan and external partners for the state Managed Medicaid pharmacy benefit. The Pharmacy Director reports to the Senior Lead Pharmacy ... statutes and regulations pertaining to both pharmacy practice laws and Managed Medicaid /PBM regulations. The Pharmacy Director stays updated on changing… more
- Evolent (Frankfort, KY)
- …meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Frankfort, KY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management ... team . We can offer you a meaningful way to...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… more
- Evolent (Frankfort, KY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management ... team . We can offer you a meaningful way to...timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to… more
- Molina Healthcare (Lexington, KY)
- …3+ years HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + ... Medical License without restrictions (free of sanctions from Medicaid or Medicare) **PREFERRED EDUCATION:** Master's in Business Administration, Public Health,… more
- Evolent (Frankfort, KY)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... will be a key member of the utilization management team . We can offer you a meaningful way to...Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Director , IT Portfolio Management & Agile Services collaborates with the business portfolio team ... instill enterprise-wide adoption of Agile methodologies and practices. The Director requires an in-depth understanding of how organizational capabilities interrelate… more
- Humana (Frankfort, KY)
- …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
- ChenMed (Louisville, KY)
- …preferred. + Strongly prefer two (2) years' previous experience as Medical Director or equivalent with a Medicare or Medicaid patient population + Board ... expanding and we need great people to join our team . The Market Clinical Director will directly...to be an existing high performing PCP partner and/or Medical Director within the ChenMed core model,… more
- Humana (Frankfort, KY)
- …of our caring community and help us put health first** The Associate Director , Business Intelligence solves complex business problems and issues using data from ... external sources to provide insight to decision-makers. The Associate Director , Business Intelligence requires a solid understanding of how...applications, and data resources. The role will lead a team of up to approx. 7-9 direct associates. **Key… more
- Baylor Scott & White Health (Frankfort, KY)
- …dashboards and reports for senior leadership, hospital senior leadership, and senior medical staff including denials from all payers, Medicare/ Medicaid audit ... **Job Summary** The Director , Denial Resource Center is responsible for the..., Denial Resource Center will lead a highly skilled team of Registered Nurses, Certified Coding Specialists, Complex Appeal… more
- Humana (Louisville, KY)
- …a part of our caring community and help us put health first** The Associate Director of the Requisition to Purchase Order (RPO) and Catalog Optimization team ... accuracy, relevance, and optimization of procurement catalogs. The Associate Director partners closely with cross-functional teams, enhancing stakeholder experiences… more
- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** Associate Director of Project Management to join the Readiness and Recovery team , focusing ... experiences, drive transformation, and support enterprise goals. The Associate Director will ensure alignment of project initiatives with business objectives,… more