- 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)
- …heart, each and every day. **Position Summary** Drive growth for Medicare Advantage External Distribution Partnerships by setting strategic sales goals, crafting ... winning strategies, and optimizing performance. Partner with senior leaders to deliver innovative solutions, streamline processes, and achieve measurable results.… 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
- Molina Healthcare (Columbus, OH)
- **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
- CenterWell (Columbus, OH)
- …and high-risk Medicare patients within a full-risk, value-based framework. The Medical Director collaborates in a dyad partnership with the Strategy ... community and help us put health first** The National Medical Director for Home-Based Care Programs is...medical direction, clinical oversight, and advancement of CenterWell Senior Primary Care's (and Conviva Senior Primary… 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 ... Doing: + Serve as the Physician match reviewer in Medical Oncology and imaging cases, that do not initially...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Baylor Scott & White Health (Columbus, OH)
- … senior leadership, hospital senior leadership, and senior medical staff including denials from all payers, Medicare /Medicaid audit activities and key ... **Job Summary** The Director , Denial Resource Center is responsible for the...improved utilization of appropriate patient care services. Collaborates with medical , clinical, HIM and other BSWH departments to ensure… more
- CVS Health (Columbus, OH)
- …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
- Humana (Columbus, OH)
- …join our team as the Head of Talent Acquisition, for our CenterWell Senior Primary Care Organization (PCO). The PCO, including CenterWell and Conviva, delivers care ... to approximately 300,000 patients from many different Medicare Advantage health plans, and is the largest provider...Advantage health plans, and is the largest provider of senior -focused primary care in the country. Across these two… more
- WelbeHealth (Columbus, OH)
- …senior care by providing an all-inclusive care option to our most vulnerable senior population. The Director , Federal Government Affairs will lead a bold ... regulatory affairs function with Congress and the Centers for Medicare and Medicaid Services (CMS) + Develop and implement...uniquely cared for. + 401k + employer match + Medical insurance coverage ( Medical , Dental, Vision) starting… more
- Humana (Columbus, OH)
- …to deliver agile, data-driven, and personalized member experiences at scale. As Director of Marketing Communication Operations, you will play a pivotal leadership ... the AVP of Marketing Operations, you will shape strategic direction, influence senior stakeholders, and lead a high-performing team of marketers. You'll drive… 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
- Cardinal Health (Columbus, OH)
- …and proactively provides guidance and trainings on policies. Reporting to the Director , Ethics & Compliance, this position supervises and manages audits to determine ... detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation… more