- Molina Healthcare (Albuquerque, NM)
- …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
- Evolent (Santa Fe, NM)
- …Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to ... for utilization management while working in conjunction with the Senior Medical Director . **Qualifications -...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Santa Fe, NM)
- …Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to ... for utilization management while working in conjunction with the Senior Medical Director . **Qualifications** +...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Santa Fe, NM)
- …MD provider is recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Santa Fe, NM)
- …MD provider is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization ... the culture. **What You'll Be Doing:** As a Field Medical Director you will be a key...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Molina Healthcare (Albuquerque, NM)
- …activities for the state health plan. Works with direct management, senior leadership/management, Corporate, and staff to develop and implement standardized provider ... and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct management and… more
- Humana (Santa Fe, NM)
- …Insurance segment's highest priority projects and initiatives, with an emphasis on Medicare Advantage strategy development. As a Senior Strategy Advancement ... company's total revenue and earnings. Team members partner with senior leaders of the business unit, and more broadly...initiatives and business areas, evolving key facets of the Medicare Advantage growth strategy, leading the development of the… more
- Humana (Santa Fe, NM)
- …with business partners to uphold ethical standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, ... a part of our caring community and help us put health first** CenterWell Senior Primary Care (PCO) is a growing provider organization that currently operates about… more
- Cardinal Health (Santa Fe, NM)
- …and proactively provides guidance and trainings on policies. Reporting to the Director , Ethics & Compliance, this position supervises and manages audits to determine ... detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation… more
- Evolent (Santa Fe, NM)
- …ongoing surveillance of coding updates from authoritative sources, including the American Medical Association (AMA), Centers for Medicare & Medicaid Services ... Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Senior Scope Analyst, Scope Management** The Specialty Scope Management team is made up… more
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