- Humana (Olympia, WA)
- …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
- Humana (Carson City, NV)
- …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...necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD… more
- Humana (Little Rock, AR)
- …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...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents… 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
- OhioHealth (Columbus, OH)
- …Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position ... will be responsible for ensuring the appropriate governmental ( Medicare and Medicaid) reimbursement is received for OhioHealth. * This position is primarily… more
- Humana (Montgomery, AL)
- …a part of our caring community and help us put health first** The Associate Director , Compliance ensures compliance with governmental requirements. ... The Associate Director , Compliance requires a solid understanding of how organization capabilities...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Commonwealth Care Alliance (Boston, MA)
- …of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible for the ... Medicare , and commercial payment methodologies and supports audit, compliance , and provider engagement initiatives. This role also provides support in… more
- SUNY Upstate Medical University (Syracuse, NY)
- …resources. Ensure accurate coding and documentation to support quality initiatives and Medicare compliance . Work closely with clinical teams across seven Primary ... Nurse (RN), or Certified Nurse Specialist (CNS), to coordinate and conduct Medicare Annual Wellness Visits (AWVs) across seven Primary Care clinics. This role… more
- Humana (Chicago, IL)
- …and help us put health first** Humana Gold Plus Integrated is seeking an Associate Director of Care Management Support who directs and implements system of ... care supports for Medicare -eligible adults with complex social needs in Illinois. This...improve quality of life, independence, and health equity. The Associate Director plays a key role in… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the Senior Director of Medicare Risk Adjustment and Analytics, the Associate Director of Risk Adjustment Data and Analytics is responsible for developing ... the Medicare and Merged Market segments. The Associate Director of Risk Adjustment Data and...Actuarial and Provider Contracting, management of external vendors, and compliance with CMS regulations. This leader is responsible for… more
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