- BlueCross BlueShield of North Carolina (NC)
- …Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is seeking a Medical Director , Medicare Strategy to join our Health Care division. In ... this dynamic role, you will serve as the expert Medical Director and Medicare clinical consultant to effectively represent Blue Cross NC externally with… more
- CVS Health (Salem, OR)
- …(work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Regulated Medicare Appeals: * Direct daily work on ... encumbrances * Board Certified in ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals… more
- Molina Healthcare (Las Cruces, NM)
- …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 practice. +… more
- CVS Health (Tallahassee, FL)
- …our members' health care and social determinant needs. The Case Management (CM) Medical Director will participate in designing, developing and deploying our ... reside in Florida and and must have a Florida medical license or be willing to obtain one. **Primary...business needs * 3-5 years of Managed Care experience; Medicare highly preferred * 3-5 year of Case Management… more
- ChenMed (St. Louis, MO)
- …preferred. + Strongly prefer one (1) years' previous experience as Medical Director or equivalent with a Medicare or Medicaid patient population + Board ... preferred. + Preferred to be an existing high performing PCP partner and/or Medical Director within the ChenMed core model, with a proven ability to manage a… more
- CVS Health (Nashville, TN)
- …group clients and their 103 million plan members. Caremark is recruiting an Executive Director for Medicare Regulatory Affairs to play a crucial role in shaping ... the Medicare regulatory landscape within the Government Services Division and...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… more
- Humana (Charleston, WV)
- …a part 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
- Ochsner Health (New Orleans, LA)
- …suite of value-based contracts, including but not limited to commercial payors, Medicare Advantage, Medicare Shared Savings Program, and Medicaid value-based ... IS, legal & compliance. + Acts as a liaison to commercial and Medicare payors, CMS, Medicaid and other governmental agencies to mitigate the significant regulatory,… more
- Banner Health (AZ)
- …government programs, member retention, network administration, and medical management administration departments. Responsible for ensuring cross-organizational ... a direct interface with the Arizona Medicaid Agency (AHCCCS), Center of Medicare and Medicaid Services (CMS), Association for Community Affiliated Plans (ACAP), and… more
- University of Miami (Miami, FL)
- …when necessary + Performs other duties as assigned by the Chief and/or clinic Medical Director + Experience with Medicare Advantage (65+) patient population ... evaluations. This role also works directly with staff, administration, medical directors, and other relevant stakeholders to assure appropriate...preferred + Completion of Medicare annual wellness exam documentation preferred + Knowledge of… more