- Humana (Providence, RI)
- …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
- CVS Health (Hartford, CT)
- …and Utilization Management Strategy support * Develop subject matter expertise on Medicare policy for the enterprise * Provide ongoing education regarding ... based anywhere in the US. **Responsibilities of this Medical Director role are related to Medicare Appeals:**... Medicare policy and appeals to the appeal... Medicare policy and appeals to the appeal nurses and territory… more
- Humana (Honolulu, HI)
- …of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. 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 + Possess analysis… more
- Highmark Health (Montgomery, AL)
- …experience in managed care pharmacy + 2 years of clinical account management experience in Medicare as part of the 4 year managed care experience + 2 years of ... the Company's Handbook of Privacy Policies and Practices and Information Security Policy ._ _Furthermore, it is every employee's responsibility to comply with the… more
- Humana (Sanford, FL)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for ... Management Program activities, and performs the activities as directed by departmental policy and leadership, current NYS DOH, CMS regulations and standards if… more
- Houston Methodist (Katy, TX)
- …activity complies with CMS, commercial payer, and regulatory requirements. + Support policy and process development to strengthen audit readiness and response. + ... procedures, and provides quality reviews. Reports results of key performance metrics to director on a timely basis. **FINANCE ESSENTIAL FUNCTIONS** + Assists in the… more
- CVS Health (Austin, TX)
- …and can be located anywhere in the United States. In this role as Medical Director MPO (Medical Policy & Operations) you will be responsible for providing ... medical care with a focus on clinical and payment policy . This Medical Director provides subject matter...and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Chief Health Actuary** **Job Class: Director Actuarial and Regional Policy Analyst** **Agency: Commerce Department** + **Job ID** : 90317 + ... regulation of the health insurance industry, including Affordable Care Act, Medicare Supplement, and long-term care markets. It involves providing expertise related… more
- Ascendis Pharma (Princeton, NJ)
- …globally, in the US, Germany & Austria, with plans for rapid expansion. As our new Director of Pricing Policy and Analytics, you will be evaluating the impact of ... with value-based contracting and innovative pricing models. + Familiarity with pharmaceutical policy impacts from IRA, Medicaid/ Medicare rules, and global price… more