- 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 ... providers). * Provide direct support to appeal nurses and dedicated Medicare part D pharmacists; supervision and participation in the Second Look… more
- Molina Healthcare (Syracuse, NY)
- **Job Description: Director , Operational Oversight ( Medicare )** **Job Summary** Responsible for planning, developing and directing the implementation of ... techniques to ensure the maintenance of performance and quality levels in the Business' products and processes. Reviews operation process designs and establishes procedures and techniques for operational standards. Confers with customers to define and resolve.… more
- Molina Healthcare (Davenport, IA)
- …for assigned markets, including D-SNP market performance management. + Function as Medicare subject matter expert and point of contact for assigned market. + ... Government Contracts on regulatory items + Under the leadership of the VP Medicare Segment Lead, this role will facilitate transparent and compliant execution of … 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
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