- Humana (Honolulu, HI)
- **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 (Honolulu, HI)
- …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 (Honolulu, HI)
- **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 (Honolulu, HI)
- …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 (Honolulu, HI)
- …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 (Honolulu, HI)
- …and related tasks; works under minimal supervision; and assists in supporting the medical director team and leaders in meeting enterprise-wide business ... community and help us put health first** The Corporate Medical Director (CMD) relies on medical...+ Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products + Must be passionate about… more
- Evolent (Honolulu, HI)
- …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 (Honolulu, HI)
- …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 (Honolulu, HI)
- …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
- Evolent (Honolulu, HI)
- …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
- Modivcare (HI)
- …may be the right fit for you! Modivcare is looking for an experienced Market Director , Hawaii to join our team . This position is responsible for directing ... and processes to implement the overall business strategy of non-emergency medical transportation (NEMT) operations. This individual will collaborate with senior… more
- Humana (Honolulu, HI)
- …to put those customers at the center of everything it does. The Director , Data Technology Solutions devises an effective strategy for executing and delivering on ... IT business initiatives. The Director , Data Technology Solutions requires an in-depth understanding of how organization capabilities interrelate across the function… more
- Humana (Honolulu, HI)
- …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 (Honolulu, HI)
- …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 (Honolulu, HI)
- …part of our caring community and help us put health first** The Associate Director of DevOps Engineering is a strategic and technical leadership role responsible for ... guiding our DevOps initiatives. You will lead a team of talented DevOps engineers, focusing on standardization, building partnerships with software delivery teams to… more
- WelbeHealth (Honolulu, HI)
- …an all-inclusive care option to our most vulnerable senior population. The Director , Federal Government Affairs will lead a bold advocacy strategy to advance ... regulatory affairs function with Congress and the Centers for Medicare and Medicaid Services (CMS) + Develop and implement meaningful engagement strategies to… more
- Humana (Honolulu, HI)
- …community and help us put health first** Humana is seeking a forward-thinking Associate Director for Human Resources Technology to join our HRIT leadership team . ... meet end-user needs and strategic goals. + Lead a team of HRIT associates and contractors, driving a culture...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Cognizant (Honolulu, HI)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued member… more