- Elevance Health (FL)
- **Appeals Medical Director - Medicare ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... law. Alternate locations may be considered. The **Appeals Medical Director ** is responsible for the appeal reviews for physical...required by State contracts or regulations if the Medical Director is filing a role required by a State… more
- CVS Health (Hartford, CT)
- …based (work at home) based anywhere in the US.** **Responsibilities of this Medical Director role are related to Medicare Appeals:** * Direct daily work on ... and Utilization Management Strategy support * Collaborative work with Medicare Quality and Compliance on an ongoing basis *...an ongoing basis * Develop subject matter expertise on Medicare policy for the enterprise * Provide ongoing education… more
- Molina Healthcare (Augusta, GA)
- …clinical leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. * Reviews quality ... referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy… more
- Molina Healthcare (IA)
- …**Job Summary** Responsible for the Management of internal business projects and programs involving department or cross-functional teams of subject matter experts, ... delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs, and monitors… more
- Centers Plan for Healthy Living (Staten Island, NY)
- … Medicare or Sales experience SCOPE INFORMATION # Direct Reports: Director of Medicare Marketing Physical Requirements: The physical requirements described ... they need for healthy living. JOB SUMMARY : The Medicare MAP Advisor- Will promote and sale MAP and... MAP Advisor- Will promote and sale MAP and Medicare Line of Business, maintains relationships, services our existing… more
- UCLA Health (Los Angeles, CA)
- …of our Medicare Advantage products. In this role, you'll partner with the Director of Medicare Product Development and Bids to guide the annual bid process, ... and compliance throughout the member lifecycle. Key Responsibilities: + Lead end-to-end Medicare Advantage product development. + Support and help manage the annual… more
- UCLA Health (Los Angeles, CA)
- Description The Assistant Director , Member Experience will work closely with the Director of Medicare Product Development & Bids to develop, lead, and ... execute the organization's member experience strategy across all Medicare Advantage products. This role is critical to improving CMS Star Ratings by enhancing member… more
- Cleveland Clinic (Cleveland, OH)
- …the Federal Clinical Trials Policy. In this role, you will report to the Director of Research Medicare Coverage Analysis and ensure compliant research billing ... respected healthcare organizations in the world. As a Research Medicare Coverage Analysis Specialist, you will be responsible for...clinical trials for research billing. + Assist the MCA Director on the development of tools and billing grids… more
- CVS Health (Austin, TX)
- …pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject matter expertise ... Health company, has an outstanding opportunity for a Medical Director . Ready to take your career to the next...in the United States. In this role as Medical Director MPO (Medical Policy & Operations) you will be… more
- UTMB Health (Galveston, TX)
- …and for directing staff in preparation of these reports. + Supports Director , Finance-Government Reimbursement in preparing annual Medicare , Medicaid and TDCJ ... to implement appropriate processes and procedures to ensure compliance with Medicare and Medicaid regulations. + Supports Director , Finance-Government… more
- NHS Management, LLC (Tuscaloosa, AL)
- …to the facility Administrator, Director of Nursing, Regional Administrator, Director of Medicare and Rehabilitation and MDS/Clinical Information Consultant. ... to the Administrator, Director of Nursing, Regional Administrator, Director of Medicare and Rehabilitation, and MDS/Clinical Information Consultant.… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …and pharmacy), appeals, medical policy (development and maintenance), and quality improvement ( Medicare Stars, NCQA). The Medical Director ensures that Aspirus ... demonstrate those values Every. Single. Day. Aspirus Health Plan is seeking a Director - Medical Director to join our team in Wausau, WI! The Medical Director… more
- Aveanna Healthcare (Sioux Falls, SD)
- …the client's physician, therapists or other care givers. + Provide input to the Medicare Director regarding the need for formulation or modification of agency ... Valid CPR, Drivers License and Automobile insurance As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements… more
- Aveanna Healthcare (Sheffield, AL)
- …the client's physician, therapists or other care givers. + Provide input to the Medicare Director regarding the need for formulation or modification of agency ... year medical social work experience + Valid CPR As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in… more
- Aveanna Healthcare (Sauk City, WI)
- …the client's physician, therapists or other care givers. + Provide input to the Medicare Director regarding the need for formulation or modification of agency ... at least one year medical social work experience As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in… more
- Aveanna Healthcare (Winchester, VA)
- …the client's physician, therapists or other care givers. + Provide input to the Medicare Director regarding the need for formulation or modification of agency ... + Master's degree in Social Work preferred As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in… more
- Centers Plan for Healthy Living (Bronx, NY)
- … Medicare or Sales experience SCOPE INFORMATION # Direct Reports: Director of Medicare Marketing PHYSICAL REQUIREMENTS: The physical requirements described ... healthy living. JOB SUMMARY : The Licensed Benefits Advisor- Medicare Sales, Maintains relationships, services our existing customers and...in a manner that is compliant with Center for Medicare and Medicaid Services (CMS) and company policies and… more
- Centene Corporation (Jefferson City, MO)
- …ALJ hearings, STARS metrics + Previous experience with ensuring high quality medical director training to review Medicare UM and appeals, Clinical review quality ... improvement activities. + Develop and have oversight of training and expertise for Medicare appeals reviews, ALJ hearings. Have oversight of STARS metrics related to… more
- Dignity Health (Redding, CA)
- …maintaining a positive fiscal stature by ensuring maximum reimbursement from Medi-Cal, Medicare , and third-party payors. The Director is accountable for ... of the assigned region-wide services. To that end, the Director must be able to respond effectively and in...a positive fiscal stature by ensuring maximum reimbursement from Medicare and third-party payers. + Ensures departmental compliance with… more
- ChenMed (New Orleans, LA)
- …3 years preferred. + Strongly prefer one (1) years' previous experience as Medical Director or equivalent with a Medicare or Medicaid patient population + Board ... we need great people to join our team. The Associate Market Clinical Director will directly supervise, performance manage and train Clinical Directors within in… more