- Atrium Health (Charlotte, NC)
- …guidelines and standards of compliance to improve overall quality and completeness of clinical documentation within the patient electronic medical record using a ... and supports the performance improvement process in conjunction with the Clinical Documentation Director . Aligns department with system strategy, vision,… more
- Alternate Solutions Health Network LLC (Detroit, MI)
- …of care based upon assessment and collaboration with the Attending Physician or Medical Director .MAJOR AREAS OF RESPONSIBILITY: Plan of Care: Implement care to ... of funeral home, etc. according to agency policy.Policies: Completes all clinical documentation following agency protocol and Medicare /Federal guidelines.… more
- CHRISTUS Health (Santa Fe, NM)
- …and Alternative Payment Models and quality deliverables working in conjunction with Medical Director of Ambulatory Quality. * Supervision and support of ... of care coordination and population health programs. In conjunction with director will oversee planning, budget, and implementation of care coordination programs… more
- CHRISTUS Health (Santa Fe, NM)
- …high standard of nursing care. Under the primary supervision of the Palliative Care Medical Director or Provider, will develop skills in and share responsibility ... age specific, quality and patient-centered care to all patients through the clinical process and manifest standards of practice with sensitivity and respect for… more
- Elevance Health (Richmond, VA)
- …Health office locations Work schedule: Monday - Friday, standard business hours.** The Medical Director Clinical Programs is responsible for designing and ... of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative...implementing clinical programs with specific medical condition focus for all lines of business enterprise… more
- CVS Health (Hartford, CT)
- …based (work at home) based anywhere in the US.**Responsibilities of this Medical Director role are related to Medicare Appeals.* Direct daily work on part C ... of experience in a Health Care Delivery System eg, Clinical Practice or Health Care Industry * Medical...Board Certified in ABMS Recognized Specialty Preferred Qualifications * Medical Management - Medicare Complaints, Grievance &… more
- CVS Health (Hartford, CT)
- …Enterprise Economics, the Strategy team supporting Medicare , as well as the core Medicare Finance team. This Executive Director will also: + Be a strategic ... analysis. + Collaborate with constituent areas including Actuarial, Enterprise Economics, Clinical , Network, Related Parties (Shared Services) and Medical … more
- Somatus (Mclean, VA)
- Overview The Director , Medicare Risk Adjustment (MRA) will lead the execution strategy and implementation of the organization's Risk Adjustment Programs to ... optimize the programs' clinical benefit, financial accuracy and ensure program compliance with...compliance with governing bodies' regulations, including the Center for Medicare and Medicaid Services. This role will partner with… more
- UCLA Health (Los Angeles, CA)
- … Director of Pharmacy Benefits Management! Reporting directly to the Chief Medical Officer of Medicare Advantage, you'll spearhead the development and ... desired + Two or more years of experience in Medicare programs, preferred + Degree from an accredited school...throughout Southern California. We're also home to the world-class medical research and clinical education capabilities of… more
- The Cigna Group (Morris Plains, NJ)
- The Director , Centene Account Management provides strategic, financial, clinical , relationship, and organizational leadership for the Medicare D and Exchange ... experience within the PBM or healthcare industry preferred; Experience in Medicare /Medicaid/Exchange market highly preferred. + Experience managing large books of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …need: As an integral part of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as an individual ... to senior leaders for decision making + Apply their clinical knowledge when assessing/auditing medical records and...and scope projects; keep project leads, senior consultants, and Director informed of key issues/ risks and meet deadlines… more
- UCLA Health (Los Angeles, CA)
- …ancillary locations throughout metro Los Angeles. We're also home to the world-class medical research and clinical education capabilities of the David Geffen ... do all this and more at UCLA Health. As an important member of our Medicare Advantage team, you will provide strategic oversight and leadership for our Member and… more
- Corewell Health (Grand Rapids, MI)
- …met. + Act as lead for expedited requests, gathering relevant information, working with Medical Director to determine if criteria is met. If expedited criteria ... payment, care management, authorizations, customer service interactions, pharmacy, Rx profiles, medical policies, and plan documents for all Medicare product… more
- CVS Health (Atlanta, GA)
- …care more personal, convenient and affordable. As the Senior Manager, Risk Adjustment ( Medicare ) will be responsible for leading Risk Adjustment for the Georgia & ... the Gulf States Medicare Market. This role will have specific responsibility for...adjustment teams, risk coding improvement activities within the region, medical record collection, provider collaboration and data sharing, general… more
- CVS Health (Jackson, MS)
- …care more personal, convenient and affordable. As the Senior Manager, Risk Adjustment ( Medicare ) will be responsible for leading Risk Adjustment for the Georgia & ... the Gulf States Medicare Market, specifically in Mississippi. This role will have...adjustment teams, risk coding improvement activities within the region, medical record collection, provider collaboration and data sharing, general… more
- Medical Mutual of Ohio (Brooklyn, OH)
- … Medicare Advantage, Medicare Supplement, and individual plans. The Clinical Operational Excellence Director Serves as a consultant providing strategic ... Founded in 1934, Medical Mutual is the oldest and one of...self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.… more
- The Cigna Group (Tucson, AZ)
- Pima County based - Medicare Provider Performance Enablement (PPE) Senior Analyst provides broad support to Sr. Supervisor, Sr. Manager, Director , and Other ... interaction with PPE staff as well as other Cigna Medicare departments. Position is exposed to all aspects of...internal departments, including but not limited to Health Services, Medical Economics, Sales and Coding in order to develop… more
- New York State Civil Service (Queens Village, NY)
- …Center (CPC); a NYS Office of Mental Health (OMH) facility, is recruiting a Clinical Director , who will serve as the Chief Medical Officer. The Clinical ... Health (OMH) facility, is recruiting a Clinical Director , who will serve as the Chief Medical...on any of the Federal and/or State Medicaid and Medicare exclusion lists. If appointed and subsequently listed as… more
- Prime Therapeutics (Columbus, OH)
- …to a Functional Business Consultant, Functional Business Owner, Manager or Director in PBM Operations, Specialty Operations, Clinical Operations, Compliance, ... our passion and drives every decision we make. **Job Posting Title** Medicare Health Plan Operations Specialist - Remote **Job Description** The Associate Functional… more
- Aveanna (Reading, PA)
- Clinical Director - Registered Nurse ApplyRefer a FriendBack Job Details Requisition #: 194969 Location: Reading, PA 19606 Category: Clinical Care and ... at $85,000 per year Position Details Position Overview The Clinical Director is responsible and accountable for...or without notice. Vaccine Requirement As an employer accepting Medicare and Medicaid funds, employees must comply with all… more
