- Molina Healthcare (Lexington, KY)
- …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 (Lexington, KY)
- …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 (Lexington, KY)
- 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 (Lexington, KY)
- **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 (Lexington, KY)
- …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 (Lexington, KY)
- …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
- Molina Healthcare (Lexington, KY)
- …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
- CVS Health (Frankfort, KY)
- …And we do it all with heart, each and every day. The Lead Director , National VBC Performance Planning & Insights will act as a strategic leader driving ... guide business decisions for national and local providers. The Director will also play a key role in supporting...efforts and adjusting strategies accordingly + Work closely with Medicare Quality team to ensure that reporting highlights areas… more
- Molina Healthcare (Lexington, KY)
- …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
- Dialysis Clinic, Inc. (Richmond, KY)
- …and ensures the patients' charts are in order in accordance with Medicare and company policies and procedures. **Schedule: 24 hours/week,** shifts start at ... per hour, depending on qualifications and experience **Benefits** : + Comprehensive medical , dental and vision benefits + Life insurance provided at no additional… more
- Catholic Health Initiatives (Lexington, KY)
- …Interns and Pharmacy Residents. May serve as the Residency Program Director or Coordinator if applicable to their location. **Job Requirements** **Requirements** ... pharmacy practice and pharmacotherapies- Knowledge of Health Plans such as Medicare , Medicaid, and commercial plans -Demonstrates knowledge and skills necessary to… more
- CVS Health (Frankfort, KY)
- …current skills and development needs. Assesses training needs and works with SIU Director on development plans for team members. Develops and maintains close working ... in a Healthcare Program Integrity, Medicaid Special Investigation or Medicaid / Medicare / Commercial Compliance role + Strong verbal and written communication… more
- Molina Healthcare (Lexington, KY)
- …with national quality and risk adjustment VPs, Regional Directors of Quality/Risk, Director of Value Based Programs, and local health plan resources. + Responsible ... program & contract design and implementation for marketplace, Medicaid and/or Medicare + Experience in a complex healthcare delivery environment, specifically with… more