- CVS Health (Hartford, CT)
- …remote based (work at home) based anywhere in the US. Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part ... and Utilization Management Strategy support * Collaborative work with Medicare Quality and Compliance on an ongoing basis *...an ongoing basis * Develop subject matter expertise on Medicare policy for the enterprise * Provide ongoing education… more
- Humana (Concord, NH)
- …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 to complex issues...of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and… more
- Molina Healthcare (Grand Island, NE)
- **Job Description** **Job Summary** Leads and directs Molina Medicare segment leaders who are responsible for the development and administration of Medicare ... markets, including D-SNP market performance management. + Function as Medicare subject matter expert and point of contact for...regulatory items + Under the leadership of the VP Medicare Segment Lead, this role will facilitate transparent and… more
- Humana (Topeka, KS)
- …our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. ... The Corporate Medical Director works on problems of diverse scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Molina Healthcare (Ann Arbor, MI)
- …improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare , ... including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge....to practice and free of sanctions from Medicaid or Medicare . **PR** **E** **FE** **R** **RED ED** **U** **C**… more
- Humana (Honolulu, HI)
- …our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The ... Corporate Medical Director works on problems of diverse scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Lansing, MI)
- …diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and monitors ... for our Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of… more
- Molina Healthcare (Columbus, GA)
- …Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + Previous leadership ... License without restrictions (free of sanctions from Medicaid or Medicare ) **PREFERRED EDUCATION:** Master's in Business Administration, Public Health, Healthcare… more
- Molina Healthcare (San Antonio, 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
- Humana (Lansing, MI)
- …of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests for services. The ... Medical Director work assignments involve moderately complex to complex issues...and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will… more