- Molina Healthcare (Dallas, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Dallas, TX)
- …3+ years HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
- Molina Healthcare (Dallas, TX)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- Molina Healthcare (Dallas, TX)
- **JOB DESCRIPTION** **Job Summary** Responsible for analysis of Medicaid and Medicare financial reports, trend, and opportunities. Includes evaluation of and ... recommendations relating to business opportunities, Medicare bids, investments, financial regulations, and similar financial projects...early signs of trends or other issues related to medical care cost. + Design and perform actuarial studies… more
- Molina Healthcare (Dallas, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Dallas, TX)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... (TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- CenterWell (Fort Worth, TX)
- …a part of our caring community and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our primary care team, ... (clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical… more
- CenterWell (Arlington, TX)
- …a part of our caring community and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our primary care team, ... (clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical… more
- Molina Healthcare (Dallas, TX)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health...National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the… more
- Methodist Health System (Dallas, TX)
- …performance related to quality, clinical outcomes and patient safety to the medical staff, hospital staff, and administration. The Director is responsible ... :** **Work Shift :** **Job Description :** Your Job: Job Purpose: The Director Clinical / Quality Management is responsible for conducting assessments of medical… more
- HCA Healthcare (Arlington, TX)
- **Description** **Introduction** We are seeking a Director of Med-Surg with Medical City Arlington to promote growth and unlock possibilities. At HCA Healthcare, ... skills and come make a difference with us! **Benefits** Medical City Arlington, offers a total rewards package that...benefits may vary by location._** We are seeking a Director of Med-Surg for our team to be an… more
- AbbVie (Dallas, TX)
- …medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's ... Texas + Austin, Texas + Denver, Colorado The Associate Director , Field Reimbursement, Botox Therapeutic manages and coaches a...understanding of Parts A, B, C and D or Medicare and associated reimbursement dynamics + Strong understanding of… more
- Molina Healthcare (Dallas, TX)
- …and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct management and ... recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region. * Leads preparation… more
- Methodist Health System (Dallas, TX)
- …building relationships with other leaders and staff. * Knowledge of Medicare /Medicaid Guidelines, JCAHO guidelines as it relates to registration/admitting. * ... contract staffing as assigned Performs other duties as assigned Methodist Charlton Medical Center is a 314-bed, full-service, acute care teaching hospital that… more
- BrightSpring Health Services (Arlington, TX)
- …with Company policies and procedures, state licensure and regulations, Medicaid and Medicare standards, as well as state reimbursement regulations + Leading case ... nursing and direct care staff, family and/or guardians, and community medical providers and professional consultants in cooperation with operations management +… more
- CenterWell (Fort Worth, TX)
- …of medical expertise with the care team through daily huddles. Helps Regional Medical Director and Center Administrator in setting a tone of cooperation in ... Doctors, Advanced Practice professionals, Pharm D, Care Coach Nurses, Medical Assistants, Behavioral Health, Specialists, Quality Based Coders, Referral Coordinators… more
- Texas Health Resources (Arlington, TX)
- …organization remains compliant and proactive. Strategic Planning Assistance - Support the Director in developing the annual work plan to strengthen compliance and ... Support & Case Review - Conduct additional reviews to assist departments handling Medicare , OIG, or non- Medicare denials. Provide expert analysis on coding,… more
- Danaher Corporation (Dallas, TX)
- …engagement and responding to customer inquiries. This position reports to the Senior Director Market Access Americas and is part of the Value and Access team. ... + Communicate regional and local coverage and reimbursement issues for Medicare , Medicaid and Commercial payers through internal meetings, payer research, and… more
- Methodist Health System (Dallas, TX)
- …Contract Strategy and Population Health, VP Value Based Care/CMO MPCACO, ACO Clinical Director and ACO Program Manager along with other team professionals working to ... relate in a professional manner to co-workers, hospital administrators, physicians, Medicare Beneficiaries, the general public and others to represent the department… more
- Elevance Health (Dallas, TX)
- …company policy and procedures. + Completes admission process as directed by Center Director . + Performs physical assessment on each patient as warranted and for new ... diagnosis. + Documents all pertinent data in the patient's medical record. + Reports all significant changes or observations...Reports all significant changes or observations to the Center Director and is responsible for the follow up on… more