- 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
- Cleveland Clinic (Cleveland, OH)
- Director Medicare Coverage Analysis Join Cleveland Clinic's Main Campus where research and surgery are advanced, technology is leading-edge, patient care is ... with the Principal Investigator and research team, patient financial services , clinical research billing office, IRB, and...Medicare regulations and state laws that apply to clinical trials research billing and trains MCA analysts. +… more
- Elevance Health (Columbus, OH)
- ** 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 ... be able to work Eastern Time Zone hours. The ** Medicare Medical Director ** is responsible for the...Director Associates. May be responsible for an entire clinical program. **How you will make an impact:** +… more
- Molina Healthcare (San Bernardino, CA)
- …NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + ... that guide and support the provisions of medical staff services . Maintains a working knowledge of applicable national, state,...including: + 2 years previous experience as a Medical Director in a clinical practice. + Current… 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....transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.… 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. ... 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 … more
- UCLA Health (Los Angeles, CA)
- …of the Medicare Advantage Risk Adjustment leadership team, the Assistant Director of Risk Adjustment is instrumental in participating in the planning with the ... director and other functional areas for implementation and execution...$120,000 - $150,000/annually. Qualifications We're seeking a self-motivated, goal-driven, service -oriented leader with: + Bachelor's degree in Healthcare Administration,… more
- CVS Health (Blue Bell, PA)
- …at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors (TM) ... actuarial team supporting CVS Health and Aetna's exciting and growing government services pharmacy business. This role manages a small team that develops, analyzes,… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …providing analytic support to help identify the most efficient means through which Medicare Stars clinical quality and patient experience performances at BCBSMA ... into a cohesive view. Under direction of the Senior Director of Population Health Analytics, the Data Scientist will...to track performance trending of patient access to care, clinical quality and consumer experience among Medicare … more
- Point32Health (Canton, MA)
- …and timelines. The Senior Manager works closely with claims, membership operations, clinical services , care management, customer relations, sales, marketing, and ... enjoy the important work we do every day in service to our members, partners, colleagues and communities. To...senior leadership, the Senior Manager, in collaboration with the Director , is responsible for all necessary product filings with… more
- BlueCross BlueShield of North Carolina (NC)
- **Job Description** The Episodic Care Manager- Medicare Advantage is responsible for performing clinical reviews to assess, facilitate, and coordinate the ... delivery of health care services for members based on medical necessity and contractual...quality and cost-effective care across the health care system. ** Clinical Evaluation and Review** + Receive assigned cases for… more
- CareOregon (Portland, OR)
- Position Title: Medical Director - Clinical Services Requisition #: 24590 Department: Department: Medical Management Administration Title of Manager: Sr ... Medical Director - Clinical Services Supervises:...Aim. Direct support may be focused on Medicaid or Medicare lines of business in a Coordinated Care Organization… more
- Brookdale Senior Living (Charlotte, NC)
- …team atmosphere along with an energized and service focused team Overview RN Director of Clinical Services Our Brookdale Carriage Club team is searching ... verify appropriate levels of care are established according to Medicare /Medicaid reimbursement levels. + Maintains care plans for each...and delegates all roles and responsibilities of the Assistant Director of Clinical Services and… more
- BrightSpring Health Services (Baltimore, MD)
- …driver's license from state of residence Knowledge/Skills/Abilities: + Extensive knowledge of Medicare home health requirements, clinical service delivery, ... achieve the highest quality of care for patients. Oversees the delivery of clinical services recommending best practice implementation optimal clinical … more
- BrightSpring Health Services (Arlington, TX)
- …+ Achieves productivity goals with regard to calls/claims per hour as determined by the Director and Clinical Hub Manager + Provide clinical support to ... This vital role serves as a key point of contact for the Clinical Hub and proactively communicates with Pharmacists, Facilities, Physicians and PDP's regarding… more
- Gentiva (Pensacola, FL)
- …passionate about what we do because our care matters. **Overview** We're looking for a ** Director of Clinical Services RN** to join our team.You will report ... directly to the Executive Director . You will be responsible for ensuring the appropriate...ReqID: 2024-115958 Category: Clinical Management Position Type: Full-Time Company: Emerald Coast Hospice Type of Service : Hospice… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview Director of Clinical Denials Management and Audit supervises a team of RN/LPN clinical reviewers as ... well as Support staff managing all areas of clinical claim pre and post audit, appeals submission, and...and customers to drive improvement in the quality of services delivered to patients. Responsibilities * Audits patients records… more
- Prime Therapeutics (Newark, NJ)
- …of that. It fuels our passion and drives every decision we make. **Job Posting Title** Clinical Account Director - Candidate Must Reside in NJ, NY or PA - Hybrid ... live in NJ, NY or PA. The role is hybrid and willing to travel.** The Clinical Account Director is responsible for the management of all client specific … more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …seeking a highly motivated individual for a full-time on-site opportunity as Medical Director of Clinical Chemistry and Point-of-Care Testing. This director ... This individual will work collaboratively with an Associate Medical Director of Clinical Chemistry as part of...Forensic Urine Drug Testing, the Joint Commission, Centers for Medicare & Medicaid Services , and the American… more
- Texas A&M University - Faculty (Dallas, TX)
- Academic Professional Track (Non-Tenure): Open Rank Clinical & Director of Clinical Compliance College of Dentistry Location Dallas, TX Open Date 11/13/2024 ... Professor. This position will include an administrative appointment as Director of Clinical Compliance and t he...of managing patient care, HIPPA compliance, and centers for Medicare and Medicaid Services . Eligible for… more
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