- USAA (Colorado Springs, CO)
- …truly makes us special and impactful. The Opportunity USAA is seeking a talented Director , Retirement Income to lead multiple teams of Health, Life or Retirement ... financial security. Responsible for driving and delivering on product, member , and financial goals for Life Co. Leads and...Risk and Compliance on interpretation of CMS (Center for Medicare and Medicaid Services) rules to provide guidance and… more
- Merck & Co. (VA)
- …health departments, integrated delivery systems, and hospitals.- The VCR is a key member of the local Customer Team that works collaboratively with other field based ... the Vaccine Key Customer Leader (VKCL), Vaccine Medical Affairs Leader (VMAL), Region Medical Director (RMD) as well as other members of the extended team.- - The… more
- InterDent (Portland, OR)
- …health outcomes. Position Overview We are seeking a dynamic Regional Clinical Director (RCD) to provide clinical leadership and operational support to approximately ... 30 Gentle Dental offices within the designated region and serve as a Dental Director (DD) for Capitol Dental. This is a high-impact leadership role central to our… more
- Stanford Health Care (Palo Alto, CA)
- …+ Serve as the subject matter expert on regulatory compliance reporting, including Medicare and Medi-Cal cost reports + Lead alignment of compliance reporting ... a Stanford Health Care job.** **A Brief Overview** The Director of Reimbursement is a key leadership role within...reports to government agencies, including but not limited to: - Medicare and Medi-Cal cost reports -Financial disclosures to the… more
- Boost Home Health (Frisco, TX)
- …and wellness by delivering personalized, coordinated in-home care. As a key member of our team, you'll help ensure that patients receive high-quality support ... ideal candidate will possess knowledge of OASIS, PDGM, QAPI functions, Medicare Conditions of Participation, and state regulations Strong computer skills, meticulous… more
- Commonwealth Care Alliance (Boston, MA)
- …optimizing network performance, and ensuring compliance with regulatory standards. The Director drives initiatives that enhance operational engagement, member ... 011230 CA-Provider Engagement & Performance Position Summary: The Director of Provider Relations leads the strategic vision and operational execution of provider… more
- Commonwealth Care Alliance (Boston, MA)
- …to a variety of audiences - Experience with managing clinical services for Medicaid/ Medicare patients - Demonstrated ability to lead and navigate large scale ... of utilization and cost and high cost cases. - Member of health plan QI Committee. Co-chair of health...health care delivery Required Knowledge, Skills & Abilities: - Medicare and Medicaid managed care experience - Demonstrated knowledge… more
- Commonwealth Care Alliance (Boston, MA)
- …**Position Summary** The Program Manager, in collaboration with the Sr Director of Delegation Partnerships and Performance, is responsible for advancing provider ... to achieve high performance on CCA's Population Health goals; including Medicare Star measures, Medicaid- Medicare Plan withhold measures, quality performance… more
- Commonwealth Care Alliance (Boston, MA)
- …Centers, Adult Day Health Centers, Adult Foster Care providers, etc.). + Lead complex negotiations and/or contracting arrangements which require developing a sound ... the financial and legal terms required for such contracting initiatives. + Lead the research, development and implementation for new, creative and potentially… more
- Commonwealth Care Alliance (Boston, MA)
- …that providers meet contractual, regulatory, and quality standards that optimize member outcomes and operational efficiency. This role is accountable for ensuring ... performance improvement. The LTSS Program Manager reports to the Senior Director of Delegation Partnerships and Provider Engagement. The Provider Engagement team… more
- Commonwealth Care Alliance (Boston, MA)
- …strong, collaborative relationships with provider partners serving dual-eligible ( Medicare -Medicaid) members. This role ensures providers are well-informed, engaged, ... engagement The Manager of Provider Communications will report to the Senior Director of Delegation Partnerships and Performance and will support the ongoing… more
- Commonwealth Care Alliance (Boston, MA)
- …regulatory compliance, and supporting operational excellence to enhance provider satisfaction and member access to care. Reporting to the Senior , Director ... Partnerships., the Senior Provider Relations Account Manager will: + Lead provider servicing activities, including onboarding, orientation presentations, and ongoing… more
- Alameda Health System (Oakland, CA)
- …The Diagnostic Imaging Education, Quality & Informatics Administrator is a key member of the Diagnostic Imaging leadership team, responsible for providing strategic ... the American College of Radiology (ACR), The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and the California Department of Public Health -… more
- Commonwealth Care Alliance (Boston, MA)
- …Duties & Responsibilities: The Manager, Utilization Management reports to the Director of Utilization Management - Oversees clinical decision review for services ... clinical areas, including but not limited to surgical procedures, Medicare Part B medications, long term services and supports...compliance with CMS, NCQA and state Medicaid requirements. - Lead preparation for internal and external audits (eg CMS… more
- Tidelands Health (Myrtle Beach, SC)
- …laws, rules, and regulations, Follows compliant charge capture in accordance with Medicare , Medicaid or Third-Party payer guidelines. + Assists with development of ... and works with Clinical Informatics to streamline charge capture process. + Lead or participate in cross-functional workgroups/committees as needed + Support all… more
- CVS Health (Annapolis, MD)
- …And we do it all with heart, each and every day. **Position Summary** The Lead Director , Medicare Member Journey Orchestration Center of Excellence ... -related processes to advance a seamless, highly personalized engagement across our member 's unique journey. You will lead cross-functional governance processes… more
- CVS Health (Hartford, CT)
- …to drive real change and improve the health of millions are endless. As Lead Director , Enterprise Strategy, you play a pivotal role helping to shape ... team is looking for a dynamic and creative team member who is passionate about driving change across the...discussions + 3+ years of experience in healthcare payor, Medicare , Medicaid or provider consulting experience + 3+ years'… more
- Elevance Health (Miami, FL)
- **Medical Director - Florida Medicare Plans** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... Florida near our Miami or Tampa locations.** The **Medical Director ** will support the following Florida Medicare ...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Elevance Health (AR)
- Provider Network Management Director ( Medicare Network Build) JR167138 **Preferred Location** : Commuting distance to the Little Rock, Arkansas office. **Hybrid ... is granted as required by law._ The **Provider Network Management Director ** develops the provider network in **Arkansas** through contract negotiations,… more
- Humana (Lansing, MI)
- …of diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead , plans, directs, and ... caring community and help us put health first** The Clinical Pharmacist Lead monitors drug development pipeline, and medical literature, while providing clinical… more
