- Eisai, Inc (Nutley, NJ)
- …of the US healthcare system across one or more major payer segments ( Medicare , Medicaid, Federal, and Commercial).Experience working with medical and pharmacy ... At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides...Access. Working closely with and reporting to the Associate Director , Access and Reimbursement, the ARM, will be the… more
- MVP Health Care (Tarrytown, NY)
- …care. The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. Service Authorization & Review: Conduct ... Medicaid members. Through collaborative efforts the Case Manager will identify the medical and psycho-social needs of designated members, act as a proactive partner,… more
- Molina Healthcare (Yonkers, NY)
- …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 (Yonkers, NY)
- …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 (Yonkers, NY)
- 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
- CVS Health (New York, NY)
- …supports over 6 million members on its core administrative platforms. The Lead Director , Technology Product Management for our Medicare Enrollment & Billing will ... tech-ops, security, etc. to ensure overall cohesion for the Medicare claims platform. You will lead a team of...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- Molina Healthcare (Yonkers, NY)
- **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
- Humana (Morristown, NJ)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll… more
- Molina Healthcare (Yonkers, NY)
- …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
- Mount Sinai Health System (New York, NY)
- **Job Description** **Mount Sinai Health System is seeking a Medical Director of Physician Engagement and CDQI!** **Background:** Mount Sinai is one of the ... improve the status quo **Role Summary:** MSHP seeks a Medical Director (MD), Physician Engagement and CDQI,...all populations served, especially our patients covered under a Medicare arrangement (MSSP or MA). The MD will report… more
- Centene Corporation (New York, NY)
- …quality accreditation standards. + Actively practices medicine **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical ... implementation of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies… more
- Mount Sinai Health System (New York, NY)
- …Description** **The Mount Sinai Health System seeks an Obstetrics and Gynecology System Medical Director for its Ambulatory Services at Mount Sinai Hospital!** ... status for nursing care, and it is the only medical center in New York State to earn Disease-Specific...a Health Care Innovation Award from the Centers for Medicare and Medicaid Services to open the first geriatric… more
- Molina Healthcare (Yonkers, NY)
- …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
- New York State Civil Service (New York, NY)
- …facility, is recruiting a Clinical Director , Psychiatric Center, M-8. The Clinical Director serves as the facility's Chief Medical Officer and is responsible ... NY HELP No Agency Mental Health, Office of Title Clinical Director , Psychiatric Center, M-8, New York State Psychiatric Institute, P27140 Occupational Category… more
- Ankura (New York, NY)
- …accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment. The Senior Director ... to complex litigation, enforcement, and regulatory challenges. Role Overview The Senior Director will support the Healthcare Payer team within Ankura's Disputes &… more
- Molina Healthcare (Yonkers, NY)
- …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
- New York State Civil Service (Bronx, NY)
- NY HELP Yes Agency Mental Health, Office of Title Educational Director 2 (NY HELPS), New York City Children's Center - Bronx Campus, P27199 Occupational Category ... cooperative projects for improvement of the program. Medicaid and Medicare : In order to be eligible for appointment and...Placement - Statewide (NY HELPS) program as an Education Director 2 if they have a permanent teaching certificate… more
- Teva Pharmaceuticals (Parsippany, NJ)
- …the Medicare Drug Price Negotiation Program (MFP). The Associate Director will translate insights into actionable strategies that align with AUSTEDO's ... Associate Director , HCP and IRA Channel Marketing Date: Oct...HCP channel dynamics and IRA / Government-related market conditions ( Medicare Part D redesign, Price negotiations) with a focus… more
- Grifols Shared Services North America, Inc (Newark, NJ)
- …and services in more than 110 countries and regions. The Associate Director , Value Access Marketing & Reimbursement is responsible for developing and executing ... access customer segment . Support reimbursement, coding, and coverage-related responsibilities for Medicare Part B, Centers for Medicare and Medicaid (CMS)… more
- Teva Pharmaceuticals (Parsippany, NJ)
- …the gross to net forecast * Monitor and track claims data for Commercial, Medical Commercial, Medicaid, Medicare , 340B and other government segments to changes ... Director , Value & Access Finance and Gross to...to net forecasting including understanding various payer channels (Commercial, Medical commercial, Medicare , Medicaid, PHS340b, VA/DoD, Tricare,… more
