- Humana (Lansing, MI)
- …a part 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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Molina Healthcare (Ann Arbor, MI)
- …NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. ... + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical … more
- CVS Health (Hartford, CT)
- …(work at home) based anywhere in the US. **Responsibilities of this Medical Director role are related to Medicare Appeals:** * Direct daily work on part ... of experience in a Health Care Delivery System eg, Clinical Practice or Health Care Industry * Medical...in ABMS or AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance &… more
- Humana (Topeka, KS)
- …a part of 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...represents Humana at Administrative Law Judge hearings; exercises independent clinical judgment and decision making on complex issues regarding… more
- Humana (Honolulu, HI)
- …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...+ Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry… more
- CVS Health (Dover, DE)
- …implementation and milestone tracking for business plans as Part of the Medicare benefit and product cycle. Directs the strategic development and implementation of ... product initiatives, including new products and product enhancements for Medicare pharmacy business strategic plans, product implementation, regulatory oversight … more
- Molina Healthcare (Columbus, GA)
- …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 (Lansing, MI)
- …The Clinical Pharmacist Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes ... of diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director , internally known as a Clinical Pharmacy Lead, plans, directs, and… more
- OhioHealth (Columbus, OH)
- …matter expert in the following areas, S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, Indirect Medical Education, Graduate Medical ... Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position… more
- SUNY Upstate Medical University (Syracuse, NY)
- …and Practice Operations and collaborate closely with Primary Care clinic Medical Directors and Nurse Leadership. Duties/Responsibilities: Identify Medicare ... Job Summary: Position Summary: Upstate University Medical Associates at Syracuse Inc. (UUMAS) is seeking...accurate coding and documentation to support quality initiatives and Medicare compliance. Work closely with clinical teams… more
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