- 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 ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex clinical… more
- CVS Health (Providence, RI)
- …approximately 6 employees and overall scope of 25-30 to develop enterprise-wide solutions ( medical cost containment and payment integrity ) to address ... industry experience in product, finance, operations, network/out of network, payment integrity , and/or related disciplines + Proven leadership/management… more
- Marriott (Bethesda, MD)
- …Y **Position Type** Management This is a temporary position. As a member of the Payment and Fraud Products team, the Director 's primary focus is Fraud related ... initiatives and support for property and above property payment capabilities. This will involve integration with many teams across the organization and understanding… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …to the Associate Director of Professional Reimbursement Strategy, the Payment Integrity Reimbursement Policy Quality Assurance (QA) Analyst is responsible ... for completing invoice and reconciliation claim audits for BCBSMA's payment integrity programs. Quality assurance audit reviews and core functions include… more
- Tufts Medicine (Burlington, MA)
- …Overview** The position is responsible for CDI program strategy and oversight. The Director will partner with the Senior Director , Clinical Revenue Cycle to ... (UM), Case Management, Quality and Physician advisors and leaders. The Director oversees the manager and clinical documentation specialists (CDSs) in planning,… more
- Northwell Health (Westbury, NY)
- **Req Number** 158136 Job Description The Director , Corporate Finance (RIO) promotes the financial viability of Northwell Health by effectively managing the ... organization's revenue capture operations. The Director works in close partnership with many aspects of the organization and is central to creating a comprehensive… more
- Intermountain Health (Broomfield, CO)
- **Job Description:** The Senior Medical Director for the Musculosketal Service Line serves as the physician leader for Peaks Region physicians and advanced ... professionals (APs). The Senior Medical Director works collaboratively in a dyad...leader for our model healthcare system as evidenced by integrity , passion, and energy; being a champion of Intermountain's… more
- State of Colorado (Denver, CO)
- …Medicare fraud, waste, and abuse (FWA) operations that includes work on: + Program Integrity + Provider Payment Reviews + Fraud Investigation + Waste and abuse ... Fraud Waste and Abuse Division Director Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4941547) Apply Fraud Waste and...ten (10) years that includes work on: + Program Integrity + Provider Payment Reviews + Fraud… more
- CVS Health (Sacramento, CA)
- …to safeguard healthcare integrity and protect patient well-being. As the Medical Director of Healthcare Fraud Investigations, you'll lead our efforts to ... do it all with heart, each and every day. Medical Director - SIU (Special Investigations Unit)... will be responsible for making both pre and post- payment claim payment determinations based on Aetna… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you see is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical ... and medical criteria. + Assists with training medical director colleagues and nursing staff ,...changes in healthcare. + Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and… more