- Molina Healthcare (Dallas, TX)
- …clinical leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. * Reviews quality ... referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy… more
- Molina Healthcare (Dallas, TX)
- …**Job Summary** Responsible for the Management of internal business projects and programs involving department or cross-functional teams of subject matter experts, ... delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs, and monitors… more
- Health Care Service Corporation (Richardson, TX)
- …company that will invest in your professional development. **Job Summary** The Executive Director , Medicare Part D Actuarial will lead the actuarial function for ... Medicare Part D products, including Individual MAPD and PDP,...for product strategy, pricing, and financial performance. The Executive Director provides actuarial leadership across product strategy, benefit design,… more
- CVS Health (Austin, TX)
- …pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject matter expertise ... Health company, has an outstanding opportunity for a Medical Director . Ready to take your career to the next...in the United States. In this role as Medical Director MPO (Medical Policy & Operations) you will be… more
- UTMB Health (Galveston, TX)
- …and for directing staff in preparation of these reports. + Supports Director , Finance-Government Reimbursement in preparing annual Medicare , Medicaid and TDCJ ... to implement appropriate processes and procedures to ensure compliance with Medicare and Medicaid regulations. + Supports Director , Finance-Government… more
- Humana (Houston, TX)
- …everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Sales Field Agents. This is a **field** **-based** role, and candidates must ... community. As part of a collaborative team of 8-12 Medicare Sales Field Agents, you'll work under the guidance...under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll… more
- Houston Methodist (Katy, TX)
- …Outpatient Prospective Payment Systems, etc. + Stays informed of the latest Medicare , Medicaid and commercial payor news, updates, and regulations and adjusts ... and procedures based on the changes with support from the Director **ESSENTIAL FUNCTIONS** **PEOPLE ESSENTIAL FUNCTIONS** + Performs management responsibilities of… more
- Humana (Austin, TX)
- …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 ...dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided… more
- Humana (Austin, TX)
- …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 (Austin, TX)
- …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