• Director , Appeals & Grievances (Medicare…

    Molina Healthcare (Akron, OH)
    …Provider disputes and appeals to ensure adherence with Molina claims processing standards and provider contractual agreements. Includes responsibility from ... processed in accordance with local Health Plan requirements * Works with Claims , Configuration, Contracting, Provider Data Management, and other business partners to… more
    Molina Healthcare (07/18/25)
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  • Clinical Documentation and Claims Integrity…

    Elevance Health (Mason, OH)
    **Clinical Documentation and Claims Integrity Director ** **Location:** Alternate locations may be considered. This position will work a hybrid model ( remote ... home-care and community based services. The **Clinical Document Improvement Director ** is responsible for leading encounter processing, diagnostic documentation and… more
    Elevance Health (07/18/25)
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  • Director , Operational Oversight…

    Molina Healthcare (Cincinnati, OH)
    …by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & Resolution you set the standards and controls that ... you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer partners… more
    Molina Healthcare (07/13/25)
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  • Director , Enrollment (Duals)…

    Molina Healthcare (Cleveland, OH)
    …rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database. ... **Knowledge/Skills/Abilities** + Holds general oversight of enrollment and premium staff at each plan site within defined region. This may include employee reviews, coaching sessions and disciplinary actions. + Monitors and enforces compliance with… more
    Molina Healthcare (07/31/25)
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  • Director , Operational Oversight - Medicare…

    Molina Healthcare (Columbus, OH)
    …5 years of experience in Medicare, DSNP and CSNP population, Enrollment, A&G, Claims , Compliance, or other Operations experience To all current Molina employees: If ... you are interested in applying for this position, please apply through the intranet job listing.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $88,453 -… more
    Molina Healthcare (07/19/25)
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  • Director , Applications (AI/Azure…

    Molina Healthcare (Columbus, OH)
    …with AI Data Integration._** + **_Experience with Member, Enrollment, and Claims applications -_** **which underpin essential business functions such as HEDIS ... reporting, Risk Adjustment (RA), and Health Plan Reporting.** + **_Azure Databricks._** + **_Python._** + **_Spark._** + **_QNXT._** **Preferred License, Certification, Association** Microsoft Technology, Mobility, ITIL To all current Molina employees: If you… more
    Molina Healthcare (06/29/25)
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  • Medical Director - Florida

    Humana (Columbus, OH)
    …The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
    Humana (07/29/25)
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  • Sr. Director , RWD Analytics and Innovation…

    Norstella (Columbus, OH)
    Sr. Director , RWD Analytics and Innovation (Healthcare & Life Sciences) Company: Norstella Location: Remote , United States Date Posted: Jul 30, 2025 Employment ... India. **Job Description :** We are seeking a dynamic and visionary Senior Director of RWD (Real-World Data) Analytics and Innovation to lead real-world data special… more
    Norstella (07/09/25)
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  • Medical Director - NorthEast Region

    Humana (Columbus, OH)
    …The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... or data requires an in-depth evaluation of variable factors. The Medical Director provides medical interpretation and decisions about the appropriateness of services… more
    Humana (07/25/25)
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  • Medical Director - Medicare Grievances…

    Humana (Columbus, OH)
    …Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on problems ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the appropriateness and… more
    Humana (08/08/25)
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