• Corporate Medical Director…

    Humana (Dover, DE)
    …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...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
    Humana (04/24/25)
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  • Principal Data Scientist - Aetna Medicare

    CVS Health (Dover, DE)
    …We are looking for a Principal Data Scientist to join our Aetna Medicare (STARS Portfolio) team at CVS Health. This high-level individual contributor will partner ... closely with the Executive Director of Aetna STARS Analytics to drive hands on...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
    CVS Health (05/29/25)
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  • Medical Director - Care Plus…

    Humana (Dover, DE)
    **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
    Humana (04/24/25)
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  • Medical Director - OneHome

    Humana (Dover, DE)
    …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 ... health, DME, skilled nursing facility and waiver requests. The Medical Director provides medical interpretation...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
    Humana (05/31/25)
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  • Medical Director - Florida

    Humana (Dover, DE)
    **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
    Humana (06/05/25)
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  • Medical Director , LTSS - Delaware

    Centene Corporation (Dover, DE)
    …and Supports (LTSS) and Medicare -Medicaid Duals populations. Additionally, the Medical Director will collaborate with other key stakeholders to provide ... diverse population preferred. **DE LTSS Only:** A full-time Long Term Services and Supports Medical Officer/ Medical Director (LTSS CMO) who is a board… more
    Centene Corporation (05/01/25)
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  • Medical Director -Payment Integrity

    Humana (Dover, DE)
    **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
    Humana (06/06/25)
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  • Medical Director - Medicaid N.…

    Humana (Dover, DE)
    **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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
    Humana (05/14/25)
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  • Medical Director , MSK Surgery

    Evolent (Dover, DE)
    …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
    Evolent (05/20/25)
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  • Field Medical Director , Cardiology

    Evolent (Dover, DE)
    …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
    Evolent (05/16/25)
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