• Manager, Medicare Compliance

    Medical Mutual of Ohio (OH)
    …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and individual plans. This position ... of Medical Mutual's Medicare Compliance Program, which supports both Medicare Advantage and Medicare Supplement products. Reporting directly to the Chief… more
    Medical Mutual of Ohio (12/23/25)
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  • Medical Director - Pharmacy Appeals

    Humana (Columbus, OH)
    …Policies and Procedures, and clinical literature as appropriate. Medical Directors will learn Medicare Part D and Medicare Advantage requirements and will ... Utilization management experience in a medical management review organization such as Medicare Advantage , managed Medicaid, or Commercial health insurance +… more
    Humana (12/03/25)
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  • Medical Director - Medicaid (remote)

    Humana (Columbus, OH)
    …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
    Humana (01/01/26)
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  • Medical Director - IP Claims Management

    Humana (Columbus, OH)
    …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicare Advantage , and Medicaid requirements and will ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
    Humana (12/11/25)
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  • Medical Director-Payment Integrity

    Humana (Columbus, OH)
    …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicaid, and Medicare Advantage requirements and will ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
    Humana (12/11/25)
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  • Medical Director - Nat'l IP UM Team

    Humana (Columbus, OH)
    …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand ... hours** **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
    Humana (11/15/25)
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  • Medical Director - OneHome

    Humana (Columbus, OH)
    …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... 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 more
    Humana (12/30/25)
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  • OneHome - Medical Director - Part Time

    Humana (Columbus, OH)
    …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... 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 more
    Humana (11/27/25)
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  • BI Analyst

    Humana (Columbus, OH)
    …Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to ... to drive business outcomes and decisions + Experience in Medicare /Medicaid, CMS (Centers for Medicare & Medicaid...+ Experience in Medicare /Medicaid, CMS (Centers for Medicare & Medicaid Services) or other Federally regulated healthcare… more
    Humana (12/19/25)
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  • Medical Director, Medical Policy

    Highmark Health (Columbus, OH)
    …knowledge to the team. They support the full-cycle ownership of commercial and Medicare Advantage medical policies, both developed internally and by vendors. ... as required. **ESSENTIAL RESPONSIBILITIES** + Full-cycle ownership of commercial and Medicare Advantage medical policy creation process including writing… more
    Highmark Health (12/24/25)
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