• Behavioral Health Medical Director…

    Humana (Columbus, OH)
    …and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will ... rehabilitation **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid products, or other Medical… more
    Humana (08/09/25)
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  • Director, Provider Service Engagement

    Medical Mutual of Ohio (OH)
    …group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans provide peace of mind to more ... self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and... specific strategies to aimed at operational and administrative performance improvement. . Supports Provider Network Management… more
    Medical Mutual of Ohio (08/08/25)
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  • Representative, Provider Relations HP…

    Molina Healthcare (Akron, OH)
    …member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, ... a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines… more
    Molina Healthcare (08/27/25)
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  • Primary Care Provider

    ChenMed (Cincinnati, OH)
    …and mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to ... be America's leading primary care provider , transforming care of the neediest population. Our mission...goals, and when leading their care teams towards their performance goals. We are an outcomes-focused, value-based organization and… more
    ChenMed (07/12/25)
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  • Medical Director - Care Plus - Florida

    Humana (Columbus, OH)
    …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... inpatient experience preferred** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
    Humana (06/28/25)
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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 ... Director will collaborate with clinicians and support staff to provide Humana members with optimal value based care in...experience in a medical management review organization such as Medicare Advantage , managed Medicaid, or Commercial health… more
    Humana (08/22/25)
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  • Delaware Valley ACO Fellowship

    Humana (Columbus, OH)
    …Medicaid Services' Medicare Shared Savings Program (MSSP), plus other commercial and Medicare Advantage value based programs. DVACO is a joint venture among ... grouping, with more than 2,000 physicians and approximately 70,000 Medicare fee-for-service beneficiaries. Additionally, DVACO currently holds performance -based… more
    Humana (07/30/25)
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  • Insurance Strategy Consultant

    Humana (Columbus, OH)
    …growth strategy, leading the development of the annual Medicare Advantage strategic plan, monitoring segment-wide operational performance , and refreshing the ... Insurance segment's highest priority projects and initiatives, with an emphasis on Medicare Advantage strategy development. As a Senior Strategy Advancement… more
    Humana (08/29/25)
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  • HEDIS Analyst

    Medical Mutual of Ohio (OH)
    …group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans provide peace of mind to more ... self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and...team and department leadership, and internal and external stakeholders.May provide input in hiring, development, and performance … more
    Medical Mutual of Ohio (08/16/25)
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  • HEDIS Analyst

    Medical Mutual of Ohio (OH)
    …group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement and individual plans. Our plans provide peace of mind to more ... the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million...self-funded group coverage, including stop loss, as well as Medicare Advantage , Medicare Supplement, and… more
    Medical Mutual of Ohio (08/08/25)
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