- Molina Healthcare (NY)
- …with the best possible service in relation to billing inquiries, service requests, suggestions and complaints. Resolves member inquiries and complaints ... fairly and effectively. Provides product and service information to members, and identifies opportunities to maintain...Member and Provider Contact Center to ensure stellar service is delivered according to Molina policies and procedures.… more
- Humana (Columbus, OH)
- … Director relies on medical background and reviews preauthorization requests for services . The Medical Director work assignments involve moderately complex to ... or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical interpretation… more
- Elevance Health (Columbus, OH)
- A proud member of the Elevance Health family of companies, CarelonRx (formerly IngenioRx) leverages the power of new technologies and a strong, clinical-first lens, ... to deliver member -centered, lasting pharmacy care. In this pivotal role on our CarelonRx Medicare Sales and Account Management team, the Pharmacy Account … more
- CVS Health (Salem, OR)
- …remote based (work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on ... sends a personal message that how we deliver our services is just as important as what we deliver....part C appeals (both provider and member /nonparticipating providers). * Provide direct support to appeal nurses… more
- Humana (Columbus, OH)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The… more
- Elevance Health (Atlanta, GA)
- ** Medicare Medical Director ** Location: This position will work a hybrid model (remote and office). The ideal candidate will **must live** within 50 miles of one ... of our Elevance Health PulsePoint locations. The ** Medicare Medical Director ** is responsible for the...for the administration of physical and/or behavioral health medical services , to ensure the appropriate and most cost-effective medical… more
- Blue Cross and Blue Shield of Louisiana (Monroe, LA)
- …AND SCOPE** + This role does not manage people + This role reports to these jobs: Director of Member Services and Member Services Supervisor ... Louisiana is preferred for all positions. **Grade 02** **POSITION PURPOSE** The Medicare Member Retention Representative is responsible for identifying potential… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …: The Medicare MAP Advisor- Will promote and sale MAP and Medicare Line of Business, maintains relationships, services our existing customers and secures ... in a manner that is compliant with Center for Medicare and Medicaid Services (CMS) and company... or Sales experience SCOPE INFORMATION # Direct Reports: Director of Medicare Marketing Physical Requirements: The… more
- Elderwood (Buffalo, NY)
- …New York, with over 40 facilities and 4,000+ employees. As an Elderwood staff member , you'll have all the tools, training and resources you need to succeed. Join ... to providing exceptional care to our residents. Medical Billing Specialist ( Medicare /Managed Care) Position Overview: + Responsible for Managed Care and Insurance… more
- Point32Health (Canton, MA)
- …health and wellbeing easier. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we ... decisions. The Senior Manager will also lead and support the annual new contract/ service area application process with CMS. Once new product designs are approved by… more
- Providence (OR)
- …and much more. Learn more at providence.jobs/benefits. **About the Team** Providence Shared Services is a service line within Providence that provides a variety ... Plan is calling an** HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA **who will:** + Perform internal...projects + Partner with the coding team, Supervisors, and Director to improve the accuracy, integrity, and quality of… more
- The Cigna Group (Atlanta, GA)
- …& Solutions). Reporting to the Network Operations Senior Manager or Director , this individual ensures the effective performance management of the provider ... All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: **Growing the MA… more
- Lancaster General Health (Lancaster, PA)
- **Summary** **Job Description** **POSITION SUMMARY:** The Associate Medical Director , Hospitalist Services is responsible for assisting the Medical Director , ... and have a reporting relationship through this agreement of services to the LRH Medical Director , Hospitalists...to other post acute settings. + Serve as a member of LRH's Medical Executive Committee, attending minimu of… more
- Humana (Columbus, OH)
- …outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or ... to innovate + **Additional Information** Typically reports to a Director of Health Services , Lead, or Corporate...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel,… more
- Humana (Columbus, OH)
- …uses their medical background, experience, and judgement to make determinations whether requested services , level of care, and/or site of service should be ... support Humana value throughout all activities. **Responsibilities** The Medical Director provides medical interpretation and determinations whether services … more
- New York State Civil Service (Ogdensburg, NY)
- …be considered. Duties Description The Director of Inpatient & Outpatient Treatment Services is an essential member of SLPC's Executive Leadership Team. Under ... NY HELP No Agency Mental Health, Office of Title Director of Inpatient and Outpatient Treatment Services , Deputy Director , Psychiatric Center 1 - Operations,… more
- MetroLink (Los Angeles, CA)
- …sessions per family member per six (6) month period. HEALTH ADVOCACY SERVICES : SCRRA offers you and your eligible dependents free health advocacy services ... Assistant Director , Finance (Grants) Print (https://www.governmentjobs.com/careers/scrra/jobs/newprint/4648818) Apply Assistant Director , Finance (Grants)… more
- Fallon Health (Springfield, MA)
- …care and are continually rated among the nation's top health plans for member experience, service , and clinical quality. Fallon Health's Summit ElderCare(R) is ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief summary of purpose:**… more
- Lake Erie College of Osteopathic Medicine (Defuniak Springs, FL)
- Assistant Director of Patient Care Services - School of Dental Medicine Overview Date Posted: 11/6/2024 Location: LECOM Defuniak Springs Dental Clinic Address: ... Full-time Description JOB SUMMARY: We are recruiting an Assistant Director of Patient Care Services for LECOM's...understanding of dealing with and processing Florida Medicaid and Medicare ; + Possess a strong sense of patient advocacy,… more
- HCA Healthcare (San Antonio, TX)
- …environment where diversity and inclusion thrive? Submit your application for our Director of Rehab Services opening with Methodist Hospital Metropolitan today ... 3% to 9% of pay (based on years of service ) + Employee Stock Purchase Plan with 10% off...benefits may vary by location._** We are seeking a(an) Director of Rehab Services for our team… more