- Humana (Montgomery, AL)
- **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Montgomery, AL)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Humana (Montgomery, AL)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- CVS Health (Montgomery, AL)
- …We are looking for a Principal Data Scientist to join our Aetna Medicare (STARS Portfolio) team at CVS Health. This high-level individual contributor will partner ... closely with the Executive Director of Aetna STARS Analytics to drive hands on...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- Humana (Montgomery, AL)
- **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Montgomery, AL)
- **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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Evolent (Montgomery, AL)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Montgomery, AL)
- …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. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Montgomery, AL)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Montgomery, AL)
- …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 ... recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (Montgomery, AL)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director you will be a key member of the utilization management team. ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Humana (Montgomery, AL)
- …our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system evaluates ... Medicare Advantage and Prescription Drug Plans using approximately 40...management, health outcomes, patient experience, and plan operations. The Director , Stars HOS Improvement and Operations is responsible for… more
- NASCO (Montgomery, AL)
- **Overview** As Executive Director , Compliance you will lead and provide oversight and management of Compliance and Privacy functions and serve as the company's ... Compliance Office. This role will have oversight responsibility for Medicare Advantage and ACA Exchanges strategy and executive relationship responsibility… more
- Evolent (Montgomery, AL)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... in Cardiology** (with Cardiology training and clinical experience). + **Unrestricted medical license** in the state of residence and willingness to obtain… more
- Prime Therapeutics (Montgomery, AL)
- …and drives every decision we make. **Job Posting Title** Trade Client Relations Director - Remote **Job Description** The Trade Client Relations Director is ... responsible for the analysis, modeling and delivery of innovative pharmacy and medical rebate strategies and cost saving solutions to Prime's clients to ensure Prime… more
- Humana (Montgomery, AL)
- …of our caring community and help us put health first** The Director , Risk Adjustment Strategy Advancement will provide business intelligence and strategic planning ... support for business segments and the company at large. The Director , Risk Adjustment Strategy Advancement requires an in-depth understanding of how organization… more
- Humana (Montgomery, AL)
- …well-being and overall experience with our products. As the Associate Director of DevOps Platforms in the Enterprise Engineering Enablement organization, you ... Work Arrangements Available **Reporting Information** + You'll report to the Director of Enterprise DevOps and Enterprise Engineering Enablement. + You'll be… more
- Otsuka America Pharmaceutical Inc. (Montgomery, AL)
- Director of Field Reimbursement Management (FRM) Position Overview We are seeking an experienced, transformative leader to serve as the Director of Field ... compliance and risk management Preferred Skills + Comprehensive knowledge of Medicare , Medicaid, and commercial insurance reimbursement regulations + Experience with… more
- CenterWell (Montgomery, AL)
- …Leaders to identify and influence enhancements to technology to improve the medical coder experience. + Oversees coding operations by identifying business partner ... of management experience + 8 or more years of Medical Coding, IPA, or similar experience + Medical...up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track record… more
- Evolent (Montgomery, AL)
- …as we solve complex business problems. **Collaboration Opportunities:** The Director , Actuarial Services utilizes and develops analytical tools to solve ... impact on the organization and patient health. This role supports both medical cost management activities and business development efforts. **What You Will Be… more