- CVS Health (Hartford, CT)
- …national Medicaid LTSS line of business including but not limited to UM, Quality, care management , and network growth as listed below.. * Support the RFP and ... products* Assure compliance with State contracted mandates for cost, quality, and care management initiatives.* Provide clinical expertise and guidance in the… more
- AmeriHealth Caritas (Newark, DE)
- …of clinical practice. + Experience in Utilization Management as a Medical Director within a managed care organization desired. + Experience with community ... **Medical Director , LTSS (must reside in DE)**...**Responsibilities:** Provides organizational leadership in the operational areas of care management , utilization review, appeals, quality improvement… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Senior Director , Third Party Compliance Oversight reports directly to the SVP, Corporate Compliance & Ethics and Risk ... and leads the Third-Party Compliance Oversight department for Commonwealth Care Alliance (CCA). This position effectively leads our Third-Party Compliance… more
- Open Sky Community Services (Worcester, MA)
- …(CCHP/BH) Community Partners Program and CCHP's Long Term Services and Supports (CCHP/ LTSS ) Community Partner Program. The Director will supervise the ... can be an overwhelming task. The vision is integrated care that ensures that every member receives the right...health and wellness a reality, not a dream. The Director of the Central Community Health Partnership will provide… more
- CVS Health (Hartford, CT)
- …of our members' health care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing ... Executive Director of Duals and other Duals Care Management leadership to collaborate across the... LTSS highly preferred * 3-5 year of Care Management experience * Ability to work… more
- Commonwealth Care Alliance (Boston, MA)
- …insurance and managed care products and services, including Medicare, Medicaid, MMP, LTSS , SNP, Duals, CHIP, and behavioral health, as well as the associated and ... **Why This Role is Important to Us:** **Position Summary:** The Director , Quality & Control Assurance reports to the VP of Quality & Control Assurance is responsible… more
- CVS Health (Columbus, OH)
- …interventions.* Work with medical director teams focusing on inpatient care management , clinical coverage review, member appeals clinical review, medical ... health populations to optimize risk adjustment, clinical quality, and care management .* Actively participate in meetings and...* Three 3+ years of experience in the managed care industry. * One 1+ year LTSS /MLTSS… more
- AmeriHealth Caritas (Newtown Square, PA)
- …care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral ... ** Director Strategy & Planning** Location: Newtown Square, PA...AmeriHealth Caritas, we are passionate about helping people get care , stay well, and build healthy communities. As one… more
- Humana (Muncie, IN)
- …and/or in-person to establish goals and priorities, evaluate resources, develop plan of care and identify LTSS providers and community partnerships to provide a ... Assisting members in maintaining Medicaid eligibility + Collaborate with Medical Director /Geriatrician/ Care Coordinator as deemed necessary to ensure cohesive,… more
- Highmark Health (Dover, DE)
- …providers for care -coordination. + Participate in rounds with the Medical Director . + Review documentation and processes for consistent practice, and to identify ... use of resources for members enrolled in DSHP Plus LTSS . Provides direct oversight to Case Managers, meets all...the day to day activities as needed. + Ensure care is medically appropriate, high quality, and cost effective.… more
- Greater Lynn Senior Services (Lynn, MA)
- …Experience * Three (3) years' experience in community nursing *Experience providing care management in a health and/or human services organization *Previous ... referral bonuses of up to $1,000 Position Overview: The LTSS Program Clinical Care Nurse will complete...for Care Transitions support.. The NRLP Clinical Care Nurse will support the Program Director … more
- Molina Healthcare (Seattle, WA)
- …Bilingual, Spanish, Spanish Speaking, MCO, Medicare Advantage, Waiver, healthcare, Health Care , LTSS , Salesforce, Data, Analysis, Reporting, Enrollment, Enroll, ... 50-75% travel. + Healthcare experience of some kind. Managed Care is a big plus! + Sales/Marketing experience and/or...(You will flex other days off). + Previous leadership/ management experience. + Proficient in Excel for reporting purposes.… more