- Molina Healthcare (Columbus, OH)
- …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
- CVS Health (Columbus, OH)
- …We are seeking a strategic and technically proficient leader to oversee Medicare data science initiatives supporting actuarial analytics and pricing. The ideal ... candidate will have deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies. This role requires a strong… more
- OhioHealth (Columbus, OH)
- …matter expert in the following areas, S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, Indirect Medical Education, Graduate Medical ... Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position… more
- Evolent (Columbus, OH)
- …Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to ... for utilization management while working in conjunction with the Senior Medical Director . **Qualifications -...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Columbus, OH)
- …Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to ... for utilization management while working in conjunction with the Senior Medical Director . **Qualifications** +...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Columbus, OH)
- …MD provider is recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Columbus, OH)
- …MD provider is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization ... the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Columbus, OH)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... with cross-functional teams, including **clinical reviewers, product, management, and senior leadership,** to improve decision-making and care outcomes. + Assist… more
- Elevance Health (Columbus, OH)
- ** Director II Provider Economics - Value-Based Specialty Care** **Location:** This role requires associates to be in-office 3 days per week, fostering collaboration ... a dynamic and adaptable workplace. Alternate locations may be considered. The ** Director II, Provider Economics** , will lead strategic analytics and payment design… more
- CenterWell (Columbus, OH)
- …MSSP, and future models. Under general direction and supervision from the ACO Director , the Senior Strategy Advancement Professional will bring a combination of ... an in-depth understanding of the healthcare industry, including value-based care, Medicare , population health, Accountable Care Organizations (ACOs), medical … more
- CenterWell (Columbus, OH)
- …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
- ChenMed (Columbus, OH)
- …1-2 days out of each week out of your home base market. The Senior Manager, Referrals is responsible for providing support to ChenMed, et. al regarding internal ... and creating trainings to guide the Chenmed company's on referral processes. The Senior Manager, Referrals is the subject matter expert in Referrals processes for… more
- Humana (Columbus, OH)
- …the core of this evolution is Humana's Insurance Segment, which provides Medicare Advantage, Medicaid, and other health plans to millions. By integrating insurance ... Strategy team plays a pivotal role in defining the future of Humana's Medicare and Medicaid businesses, which generate the majority of the company's total revenue… more
- Humana (Columbus, OH)
- …with business partners to uphold ethical standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, ... a part of our caring community and help us put health first** CenterWell Senior Primary Care (PCO) is a growing provider organization that currently operates about… more
- Gentiva (Mount Vernon, OH)
- …our team in **Mount Vernon, OH.** You will report directly to the Executive Director , Administrator, or Senior Patient Care Manager. You will be responsible for ... referrals/inquiries in a timely, professional, and compassionate manner, including triage of medical concerns within scope of practice. + Preparing for, serving on,… more