- Humana (Harrisburg, PA)
- …or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical ... caring community and help us put health first** The Medical Director relies on medical ...Prefer Medicaid experience + Utilization management experience in a medical management review organization, such as Medicare … more
- CVS Health (Hartford, CT)
- …(work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Part C Medicare Appeals. This position is primary ... 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...Board Certified in ABMS Recognized Specialty Preferred Qualifications * Medical Management - Medicare Complaints, Grievance &… more
- Elevance Health (Mendota Heights, MN)
- ** Director Financial Operations - Government Finance Medicare and Medicaid** **Location:** Alternate locations may be considered. This position will work a ... 50 miles of one of our PulsePoint locations. The ** Director Financial Operations** is responsible for providing strategic planning...Minimum of 5 years in Government Business finance in Medicare and Medicaid is highly preferred. + Medicaid and… 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
- Cognizant (Minneapolis, MN)
- …Lightning SFDC Integration and SFDC Configuration. Additionally domain experience in Medicare and Medicaid Claims Claims and Payer is essenti **Responsibilities** + ... to customize and optimize Salesforce environments. + Domain experience in Medicare and Medicaid Claims Claims and Payer to address industry-specific requirements.… 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
- CVS Health (Jackson, MS)
- …business.** CVS Health/Aetna is working to transform the way [State] Medicare beneficiaries experience health care - improving quality, emphasizing whole-person ... Manager to support the growth of our industry leading Medicare business. This is a highly collaborative role that...highly collaborative role that will report to the Sales Director and drive local broker distribution and sales success.… more
- AmeriHealth Caritas (Detroit, MI)
- …facilitating authorizations/referrals for the utilization of services. + Interfaces with the Medical Director and other Integrated Care Team participants on ... impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth...this job:** Under the supervision of the Supervisor of Medicare LTSS Operations, the Medicare LTSS Care… more
- Henry Ford Health System (Troy, MI)
- GENERAL SUMMARY: Responsible for the retention and growth of the Medicare and Marketplace lines of business (both Individual and Group) accounting for more than $400 ... planning and marketing support. Coordinate the development and implementation of Medicare Advantage sales strategies, compliance activities and oversight of external… more
- AmeriHealth Caritas (Newtown Square, PA)
- …with medical policies. When necessary, cases are escalated to the Medical Director for further review. The reviewer independently applies medical ... impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth...+ 2+ years of experience conducting UM reviews in Medicare .; + Proficiency in Electronic Medical Record… more