- Humana (Denver, CO)
- …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 ...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All… more
- Omnicell (Watertown, NY)
- ** ASSOCIATE DIRECTOR , PHARMACY OPERATIONS** Omnicell Specialty Pharmacy is looking for an experienced pharmacy leader to oversee on-site operations for a new ... + Five or more years of transplant experience with a strong understanding of Medicare Part B billing requirements is preferred. + A thorough understanding of the… more
- Tufts Medicine (Lawrence, MA)
- **Tufts Medicine Care at Home** is currently seeking an ** Associate Medical Director ** to join our **hospice** team in the greater **Lowell** area. This position ... medical services (RN, NP, PA, LPN, CNA), and assure compliance with medical standards of care for hospice. +...+ Re-certifying patients, as appropriate, for continuation of the Medicare Hospice Benefit at the appropriate levels of care.… more
- BAYADA Home Health Care (York, PA)
- …is currently seeking an experienced health care manager to fill the position of ** Associate Director ** in our Harrisburg, PA Senior Living office. Are you ... of all services provided by your staff to ensure compliance and client satisfaction while ensuring adequate staff education,...industry, preferably in home health care + Knowledge of Medicare regulations, including OASIS and PPS + Knowledge of… more
- Humana (San Juan, PR)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Humana (Washington, DC)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... at the Inpatient level. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national clinical… more
- Humana (Denver, CO)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Bristol Myers Squibb (Princeton, NJ)
- …of a team responsible for accurate and timely Managed Care Commercial and Medicare Part D rebate processing and payments, data stewardship and compliance ... BP true-up, BP modeling of contingent/portfolio agreements, legal requests, SOX compliance , deal analytics, contract performance analytics and ad hoc data analytics… more
- Humana (Frankfort, KY)
- …2 Medicare appeal processes within the organization. This role ensures compliance with Medicare regulations and strives to drive five-star performance for ... and help us put health first** As part of Humana's Resolution Team, the Director of Grievances and Appeals is responsible for overseeing the management of Level 1… more
- Humana (Raleigh, NC)
- …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