- Humana (Trenton, NJ)
- …a part 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, SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director ...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All… more
- Humana (Trenton, NJ)
- …health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments ... data requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical... rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and support staff to… more
- Humana (Trenton, NJ)
- …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director ... 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 (Trenton, NJ)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... at the Inpatient level. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national clinical… more
- Humana (Trenton, NJ)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Humana (Trenton, NJ)
- …of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Sanofi Group (Morristown, NJ)
- …pricing team responsible for executing all government pricing calculations in full compliance with all Medicaid, Medicare and VA Healthcare Act regulations. ... **Job Title:** Director , Government Pricing **Location:** Morristown, NJ **About the...analysis, and reporting of all government pricing programs in compliance with applicable laws and regulations. Maintaining timely and… more
- Ascendis Pharma (Princeton, NJ)
- …develop their skills. Ascendis Pharma is looking to hire an experienced Director , Market Access Contract Operations to join our team. Responsibilities will include ... demonstrating strong leadership, project management, and communication skills. As the Director , Market Access Contract Operations, you will oversee all aspects of… more
- CenterWell (Trenton, NJ)
- …access. The Director partners closely with clinical leadership, operations, finance, compliance , and IT, and manages both onshore and offshore teams. The role ... caring community and help us put health first** A ** Director of Authorizations & Eligibility** is a senior revenue...methodologies. ** Compliance & Risk Management** * Ensure compliance with Medicare , Medicaid, and commercial payer… more
- Aveanna Healthcare (Clark, NJ)
- Clinical Director - Home Care - RN ApplyRefer a FriendBack Job Details Requisition #: 207908 Location: Clark, NJ 07066 Category: Nursing Salary: $85,000.00 - ... when you come to Aveanna. Position Overview The Clinical Director is responsible and accountable for the planning, organizing,...- Monitor staffing patterns of all patients - Ensure compliance with Nurse Practice Act - Evaluate and supervise… more