- Elevance Health (Costa Mesa, CA)
- ** Medical Director - Medicare and Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... required by law. **Candidates must live in California.** The ** Medical Director ** will be responsible for utilization...will be responsible for utilization review case management for Medicare and Medicaid in the California market while also… more
- CVS Health (Hartford, CT)
- …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 C ... * Board Certified in ABMS or AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- Molina Healthcare (Madison, WI)
- …3+ years HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
- Humana (Olympia, WA)
- **Become 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 work assignments involve moderately complex to complex issues...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- ChenMed (Richmond, VA)
- …preferred. + Strongly prefer one (1) years' previous experience as Medical Director or equivalent with a Medicare or Medicaid patient population + Board ... preferred. + Preferred to be an existing high performing PCP partner and/or Medical Director within the ChenMed core model, with a proven ability to manage a… more
- Humana (Austin, TX)
- …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 ... SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided… more
- Robert Half Finance & Accounting (Eatontown, NJ)
- …located in Eatontown and offers a hybrid schedule, has an opportunity for a Director Medicare /Medicaid Reimbursement. + The Director will have advanced level ... to support employees + Paid Time Off (PTO) + Medical and Prescription Drug Insurance + Life & Accidental...partnership with the Vice President of Corporate Reimbursement, the Director will manage the completion of DSH, Medicare… more
- Humana (Little Rock, AR)
- …a part of 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...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- CVS Health (Chicago, IL)
- …heart, each and every day. **Position Summary** Aetna is recruiting for a Lead Director , Actuarial - Medicare who will be responsible for understanding and ... driving action on Medicare Network Insights and curating support for this important...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- Molina Healthcare (Des Moines, IA)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with ... the standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of… more
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