- 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 ... encumbrances* Board Certified in ABMS Recognized Specialty Preferred Qualifications * Medical Management - Medicare Complaints, Grievance & Appeals experience.*… more
- Molina Healthcare (Long Beach, CA)
- …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
- Elevance Health (Richmond, VA)
- …office locations Work schedule: Monday - Friday, standard business hours.** The Medical Director Clinical Programs is responsible for designing and implementing ... of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative...clinical programs with specific medical condition focus for all lines of business enterprise… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... health episodic and per diem requests. The Medical Director provides medical interpretation... Medicare population and reports to the Lead Medical Director . Other duties: + Identify … more
- The Cigna Group (Houston, TX)
- …development and execution of the medical cost management and strategy. The Medicare Affordability Director must be an experienced leader with a deep ... The Medicare Affordability Director serves as the...for clinical support, UM, site of care and other medical and behavioral management areas, while connecting, influencing and… more
- The Cigna Group (Bloomfield, CT)
- …provide significant opportunities for a leader to shape a significant component of the Medicare Growth strategy. The Director of Telesales will lead strategy and ... - United States** **Summary** The Direct to Consumer (DTC) Medicare channel is a significant driver of current and...driving strategy and execution of targeted technology investments. The Director of Telesales will build the necessary strategy and… 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 ... affordable. Position Summary As a direct of the CFO, Medicare this role will work to ensure that the...Enterprise Economics, Clinical, Network, Related Parties (Shared Services) and Medical Economics to execute on growth priorities. + Partner… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …true colors to blue. Reporting to the SVP, Sales & Client Management, the Director , Group Medicare Sales, is an integral member of the leadership team-driving ... BCBSMA's purposeful re-entry into the Group Medicare Advantage Market. The role will have responsibility for Group Medicare Advantage and Medicare … more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- CVS Health (New York, NY)
- …for energetic team member to bring discipline and strategic thinking to our Medicare Marketing Efforts. The Lead Director , Medicare Marketing Strategic ... critical role in enabling, optimizing and advancing the Aetna's Medicare Marketing. This role will serve as a key...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… more
- CVS Health (Hartford, CT)
- …convenient and affordable. Position Summary Works closely with the Executive Director , National SNP Sales Strategy, in the creation, refinement and delivery ... a well-rounded SNP subject-matter-expert in sales, distribution, marketing and Medicaid/ Medicare processes, contributing holistic support to any recommendation. +… 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 ... ensure program compliance with governing bodies' regulations, including the Center for Medicare and Medicaid Services. This role will partner with leadership to… more
- CVS Health (Hartford, CT)
- …Stars, and Revenue Integrity teams for each of the 4-5 regions that Medicare operates under. This organization will help strengthen the teams that currently support ... important part in helping to align and communicate the Medicare Local Market teams around current performance, and the...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… 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 the David… more
- CVS Health (Springfield, IL)
- …process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment.This Medical Director provides subject matter ... Position Summary Aetna, a CVS Health company has an outstanding opportunity for a Medical Director . Ready to take your career to the next level with a Fortune 6… more
- CVS Health (Hartford, CT)
- …strategic leadership and oversight for financial planning and analysis for a Medicare Local Market by managing a team of financial analysts, coordinating budgeting ... budget presentations for senior leadership, and day-to-day ad-hoc analyses + Medicare Experience. EducationBachelor or similar work experience This is a hybrid… more
- UCLA Health (Los Angeles, CA)
- …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 ... locations throughout metro Los Angeles. We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of… more
- Elderwood (Buffalo, NY)
- …a full time Medical Billing Specialist to join our team. Medical Billing Specialist ( Medicare /Managed Care) Position Overview: + Elderwood Administrative ... package, Life Insurance, Medical , Dental, and Vision insurance Responsibilities Medical Billing Specialist ( Medicare /Managed Care): + Review remittances for… more
- CVS Health (Buffalo Grove, IL)
- …care more personal, convenient and affordable. Position Summary The Sr. Clinical Pharmacist, Medicare - Medical Affairs leads within the Medical Affairs ... across the organization to support customer needs. The Sr. Clinical Pharmacist, Medicare - Medical Affairs is responsible for supporting the creation… more
- AdventHealth (Altamonte Springs, FL)
- …and State Medicaid programs, including changes affecting hospital reimbursement of Medicare bad debt, graduate medical education, disproportionate share hospital ... Reimbursement Analyst is responsible for preparing and filing the annual Medicare , Medicaid, and Champus/Tricare cost reports; preparation of reopening and appeal… more