- CVS Health (Trenton, NJ)
- …supporting the Aetna Northeast Medicaid plan and the UM team. The UM Medical Director will ensure timely and consistent responses to members and providers ... and every day. **Position Summary:** Ready to take your Medical Director skills to the next level...opportunity with Aetna, a CVS Health company! Aetna operates Medicaid Managed Care Plans in multiple states: Arizona, Florida,… more
- Humana (Trenton, NJ)
- …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
- CVS Health (Trenton, NJ)
- …it all with heart, each and every day. **A Brief Overview** The Lead Director , Provider Data Compliance is responsible for overseeing the compliance of provider data ... initiatives to support audit readiness and collaborates with Compliance, Legal, Medicaid Health Plans, Network Contracting, and Provider Relations to ensure… more
- Humana (Trenton, NJ)
- …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 (Trenton, NJ)
- …our caring 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...Medical Directors will learn Medicare, Medicare Advantage and Medicaid requirements, and will understand how to operationalize this… more
- RWJBarnabas Health (Oceanport, NJ)
- Director , Corporate Reimbursement (Hybrid/Remote) - Oceanport, NJReq #:0000180233 Category:Professional / Management Status:Full-Time Shift:Day Facility:RWJBarnabas ... $209,501.00 per year Location: Oceanport, Oceanport, NJ 07052 Job Title: Director Location: Barnabas Health Corp Department: Corporate Reimbursement Req#: 0000180233… more
- Humana (Trenton, NJ)
- **Become 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 work assignments involve moderately complex to complex issues...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Trenton, NJ)
- **Become 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 work assignments involve moderately complex to complex issues...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Trenton, NJ)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Humana (Trenton, NJ)
- **Become 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... management review organization such as Medicare Advantage, managed Medicaid , or Commercial health insurance + Experience with national… more