- Humana (Jefferson City, MO)
- **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 (Jefferson City, MO)
- …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 (Jefferson City, MO)
- **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 (Jefferson City, MO)
- **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 (Jefferson City, MO)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... activities as assigned by the managing Medical Director ** Travel: While this is a remote ...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Humana (Jefferson City, MO)
- …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 (Jefferson City, MO)
- **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
- Centene Corporation (Jefferson City, MO)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Supervisory Medical Director at Centene plays a critical role in ... to our members. This role further assists the Senior Medical Director or Chief Medical ...Managed care/ clinical experience; experienced with commercial, Medicare and Medicaid lines of business required + 1+ years Supervisory/management… more
- CenterWell (Jefferson City, MO)
- …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 (Jefferson City, MO)
- …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 (Jefferson City, MO)
- …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 (Jefferson City, MO)
- …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 (Jefferson City, MO)
- …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 (Jefferson City, MO)
- …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
- Centene Corporation (Jefferson City, MO)
- …and available resources + Perform complex financial analyses to identify medical cost improvement opportunities, develop strategies to reach financial goals, and ... network development or provider relations experience. Previous experience in Medicaid /Medicare contracting and negotiating hospital, large physician groups and… more
- Humana (Jefferson City, MO)
- …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
- Public Consulting Group (Jefferson City, MO)
- …issue research. Additional this position will assist in performing claims processing, medical record audits for all implemented agencies, and assist with other ... errors and denied claim research results, final remittance advice processing, and medical record reviews that will include discussion with internal management to… more
- Humana (Jefferson City, MO)
- …and other skills IT Associates needs to succeed. + Partners with Associate Director to develop, refine, and prioritize the skilling roadmap, aligning future skills ... allows, the rest of IT. + Supports the Associate Director in all reporting (eg, and type of learning...PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Humana (Jefferson City, MO)
- …Leader - AEP Readiness & Automation **Location:** Louisville, KY / Remote **Department:** Technology Solutions **Reports To:** Director , Technology Solutions ... ongoing interruptions to protect member PHI / HIPAA information \#LI- Remote Travel: While this is a remote ...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Humana (Jefferson City, MO)
- …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