- Humana (Nashville, TN)
- …a part of our caring community and help us put health first** The Director , Financial Planning & Analysis analyzes and forecasts financial, economic, and other data ... accurate and timely information for strategic and operational decisions. The Director , Financial Planning & Analysis requires an in-depth understanding of how… more
- Prime Therapeutics (Nashville, TN)
- …including pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid . The Sr Director , Pharm Trade Relations leads a team of ... Sr Dir Pharmacy Trade Relations - Remote **Job Description** The Sr Director , Pharmaceutical Trade Relations is responsible for managing Prime's Trade Relations… more
- Humana (Nashville, TN)
- …Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical ... policies, clinical standards, and (in some cases) contracts. The Medical Director provides medical interpretation and decisions about the appropriateness of services… more
- Humana (Nashville, TN)
- …support across a broad range of actuarial, managerial, and business needs for Medicaid -specific product lines. The Lead Actuary will serve as a project manager in ... and documentation. The Lead Actuary will be responsible for Medicaid -specific functions such as capitation rate review, drafting rate...on the business. They will work closely with the Director to ensure key workstreams are meeting timelines and… more
- Humana (Nashville, TN)
- …community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. The Behavioral ... Health Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of… more
- Humana (Nashville, TN)
- …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 ... must be able to start with 30-60 days of hire. The Medical Director actively uses their medical background, experience, and judgement to make determinations whether… more
- Humana (Nashville, TN)
- …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 provides medical interpretation and decisions about the appropriateness of services… more
- Humana (Nashville, TN)
- …a part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). ... The Medical director work assignments involve moderately complex to complex issues...medical management review organization such as Medicare Advantage, managed Medicaid , or Commercial health insurance + Experience with national… more
- HCA Healthcare (Nashville, TN)
- …care like family! Jump-start your career as a Patient Access Market Assistant Director today with Parallon. Rotation to multiple hospitals is required including but ... join our team as a Patient Access Market Assistant Director . We care for our community! Just last year,...cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon… more
- Elevance Health (Nashville, TN)
- **Clinical Documentation and Claims Integrity Director ** **Location:** Alternate locations may be considered. This position will work a hybrid model (remote and ... home-care and community based services. The **Clinical Document Improvement Director ** is responsible for leading encounter processing, diagnostic documentation and… more