• Director , Financial Planning & Analysis…

    Humana (Montpelier, VT)
    …a part of our caring community and help us put health first** The Director , Financial Planning & Analysis analyzes and forecasts financial, economic, and other data ... accurate and timely information for strategic and operational decisions. The Director , Financial Planning & Analysis requires an in-depth understanding of how… more
    Humana (08/26/25)
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  • Medicare- Medicaid Pharmacy Director

    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 ... Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of managed care… more
    Humana (08/13/25)
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  • Medical Director - Behavioral Health, Aetna…

    CVS Health (Oklahoma City, OK)
    …their clinical quality and effective use of health care resources. **This is a remote -based (work from home) role.** In this role as Medical Director (Behavioral ... Health), you will: * Provide leadership and day-to-day physician oversight for utilization management team, including the management of high-risk cases and medical necessity decisions * Provide comprehensive behavioral health care management to facilitate… more
    CVS Health (08/27/25)
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  • Director , Corporate Reimbursement (Hybrid/…

    RWJBarnabas Health (Oceanport, NJ)
    Director , Corporate Reimbursement (Hybrid/ Remote ) - Oceanport, NJReq #:0000180233 Category:Professional / Management Status:Full-Time Shift:Day ... $209,501.00 per year Location: Oceanport, Oceanport, NJ 07052 Job Title: Director Location: Barnabas Health Corp Department: Corporate Reimbursement Req#: 0000180233… more
    RWJBarnabas Health (06/20/25)
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  • Medicare/ Medicaid Claims Editing…

    Commonwealth Care Alliance (Boston, MA)
    011250 CCA-Claims Hiring for One Year Term **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not ... this time._** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr.… more
    Commonwealth Care Alliance (08/26/25)
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  • Senior Medicaid & Medicare Reimbursement…

    OhioHealth (Columbus, OH)
    …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 responsible for… more
    OhioHealth (06/07/25)
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  • Medicare/ Medicaid Claims Reimbursement…

    Commonwealth Care Alliance (Boston, MA)
    011250 CCA-Claims **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this ... time._** **Position Summary:** Reporting to the Director , Claims Operations and Quality Assurance, the Claims Sr....Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports… more
    Commonwealth Care Alliance (05/31/25)
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  • Remote Child Behavioral Medical…

    Centene Corporation (Salem, OR)
    …benefits including a fresh perspective on workplace flexibility. **We're Hiring: Remote Child Behavioral Medical Directors** Centene Corporation is a leading ... government-sponsored healthcare coverage, providing access to affordable, high-quality services to Medicaid and Medicare members, as well as to individuals and… more
    Centene Corporation (08/15/25)
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  • Field Medical Director , Interventional…

    Evolent (Dover, DE)
    …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology to ... innovation, continuous improvement, and clinical excellence. + **This position is 100% Remote and can be completed from any state. Multiple opportunities for a… more
    Evolent (07/30/25)
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  • Program Director , Quality Improvement…

    Molina Healthcare (Davenport, IA)
    …surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Program Director is a key Quality Improvement (QI) leader within the ... needs. + Manages QI programs with oversight from the Director , AVP and VP as needed. + Collaborates and...of and experience with HEDIS programs. + 2 years Medicaid experience + 2 years Medicare experience + 3… more
    Molina Healthcare (08/02/25)
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