• Medical Director -Payment Integrity

    Humana (Austin, TX)
    …discussions with an external provider. Some roles include an overview of coding practices and clinical documentation, dispute/grievance and appeals processes, ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
    Humana (09/26/25)
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  • Medical Director - Claims Management

    Humana (Austin, TX)
    …may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, dispute, grievance, and appeals processes, ... Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care received by members in an… more
    Humana (09/17/25)
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  • Director of Payment Integrity Consulting

    CGI Technologies and Solutions, Inc. (Dallas, TX)
    …domains, including pre-payment review, post-payment audit, FWA detection and prevention, coding accuracy, clinical integrity, and provider data management. * ... ** Director of Payment Integrity Consulting** **Category:** Finance **Main...including pre-payment review, post-payment audit, FWA detection and prevention, coding accuracy, clinical integrity, and provider data… more
    CGI Technologies and Solutions, Inc. (09/25/25)
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  • Medical Director - Spine

    CVS Health (Houston, TX)
    …Responsible for predetermination reviews ad reviews of claim determinations, providing clinical , coding , and reimbursement expertise, using multiple computer ... transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources....Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from… more
    CVS Health (08/08/25)
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  • Director Managed Care Contracting

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Director Managed Care Contracting position is responsible for the development, negotiation, maintenance and payer relations of the Houston ... payment contracts, quality metric bonus program and risk contracts. The Director position responsibilities include overseeing the activities of the department staff,… more
    Houston Methodist (09/12/25)
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  • Medical Director - (Pain Management SME)

    CVS Health (Austin, TX)
    …for predetermination reviews ad reviews of claim determinations, providing clinical , coding , and reimbursement expertise. **Required Qualifications** * ... Health Company, has an exciting opportunity for a Medical Director (Pain Management) that can be remote based, work...directing case management. In this role you will provide clinical expertise and business direction in support of medical… more
    CVS Health (09/06/25)
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  • Director , Practice Management

    Community Health Systems (Longview, TX)
    …& Reward Programs + Exclusive Discounts & Perks* **Job Summary** The Director , Practice Management is responsible for the operational, financial, and clinical ... compliance, and financial sustainability across all managed practices. The Director collaborates with physicians, hospital leadership, and administrative teams to… more
    Community Health Systems (07/24/25)
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  • Clinical Data Abstraction Specialist

    Apex Health Solutions (Houston, TX)
    Job Title: Clinical Data Abstraction Specialist Supervisor: Director , VBC Operations Required License(s)/ Certification(s): Certified Risk Adjustment Coder ... (CRC), Certified Professional Coder (CPC), or Certified Coding Specialist (CCS) FLSA Status: Nonexempt Summary: Clinical Data Abstraction Specialist is… more
    Apex Health Solutions (09/26/25)
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  • Dialysis Clinical Manager Registered Nurse…

    Fresenius Medical Center (Marble Falls, TX)
    …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions...for unexcused and missed treatments in collaboration with the Director . + Plans, coordinates and acts as the liaison… more
    Fresenius Medical Center (09/16/25)
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  • Clinical Documentation Specialist…

    Prime Healthcare (Harlingen, TX)
    …CDS Supervisor is responsible for the implementation and improvement of the clinical documentation improvement program at the facility and supervises clinical ... synergistically with other concerned departments and personnel. Work closely with the Director of CDI/Data Quality, CDS Manager and/or CDS Supervisor, Supervisor of… more
    Prime Healthcare (10/03/25)
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