- Humana (Columbus, OH)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other ... Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance +… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …true colors to blue. Reporting to the SVP, Sales & Client Management, the Director , Group Medicare Sales, is an integral member of the leadership team-driving ... BCBSMA's purposeful re-entry into the Group Medicare Advantage Market. The role will have responsibility for Group Medicare Advantage and Medicare … more
- Somatus (Mclean, VA)
- …and mental well-being + Community engagement opportunities + And more! The Sr. Director , Medicare Risk Adjustment (MRA) will lead the execution strategy and ... Minimum 5 years of leadership/management experience required. + Proven experience with commercial and/ or Medicare Advantage risk adjustment functions. + Proven… more
- The Cigna Group (Bloomfield, CT)
- …is a critical position on the NANPM Team and a direct report to the Senior Director of NANPM Medicare & Commercial Alignment. Experience with Medicare ... This is a ** Medicare Advantage position** WORK LOCATION: REMOTE position The...point of accountability for the programs impacting both the commercial and senior segments + Leads annual business reviews… more
- CVS Health (Columbus, OH)
- …medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ( Medicare /Medicaid) programs and individual client ... Director UM decisions. If specifically assigned to one business segment (ie, Medicare clients), each director will become sufficiently skilled in various UM… more
- Humana (Columbus, OH)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other ... Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. +… more
- Humana (Columbus, OH)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other ... Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. +… more
- Stryker (MD)
- …of their businesses. This person should have a material understanding of Medicare reimbursement and a general understanding of Commercial plans. **Essential ... link to learn more:US Stryker employee benefits. (https://d25zu39ynyitwy.cloudfront.net/oms/000000/document/2024/6/SMVZW\_USStrykerEmployeebenefits/USStrykerEmployeebenefits.pdf) The ** Director , Health Policy and Reimbursement** is a member of… more
- Point32Health (Canton, MA)
- …of commercial (fully funded and self-funded), exchange, Medicaid and Medicare products required. + Experience in managed care systems required. + Ideal ... at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director , Utilization Management is responsible for directing, leading, and… more
- LifePoint Health (Rutherfordton, NC)
- …and knowledge and experience operating community hospitals and healthcare organizations. The Director of Case Management is responsible for the oversight of Case ... Geometric Length of Stay (GLOS) for each patient. *Essential Functions: * The Director is responsible for the overall direction and management of these areas,… more
- CVS Health (Austin, TX)
- …Program (MSSP), ACO REACH, or other value-based care arrangements, especially in Medicare Advantage. + Prior commercial product launch and/or Go-to-Market ... more personal, convenient and affordable. **Position Summary** As the Director of Commercialization and Growth, part of the Health...teams a plus. + Experience in Managed Care space ( Medicare Advantage or Managed Medicaid) a plus. + Knowledge… more
- Mitsubishi Chemical Group (Jersey City, NJ)
- …objectives with assigned specialty distributor and specialty pharmacy accounts. The Associate Director of Trade will collaborate with members of Supply Chain, ... Commercial , and corporate functions to achieve individual, group, and...and experience in different access and reimbursement models, including Medicare Parts B and D, Medicare Advantage… more
- Ascension Health (Austin, TX)
- …two Accountable Care Organizations participating in the Enhanced Track of the Medicare Shared Savings Program, multiple commercial value-based models and a ... Ascension Texas has an immediate opening for a Medical Director of Population Health who will serve as a...(MD) or Doctor of Osteopathy (DO) or Doctor of Dental Surgery (DDS) or Doctor of Dental … more
- Humana (Columbus, OH)
- …of established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about ... and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims...outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time… more
- Arvinas (New Haven, CT)
- …specialty pharmacy. + Understanding of Benefit Design & Economics associated with Commercial , Medicaid and Medicare reimbursement for oral drugs with Oncology ... member of the Market Access Leadership team, the Senior Director , US Pricing & Contracting Strategy will lead the...serves as the functional lead for all Arvinas's US Commercial and Government Contracting & Pricing. They will be… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …national antifraud associations. The attorney will also oversee compliance for the Medicare and Federal Employee programs related to FWA and respond to Compliance, ... creation of controls to manage fraud, waste and abuse schemes. + Support the Medicare compliance program by overseeing Medicare fraud waste and abuse activity in… more
- Gentiva (Akron, OH)
- …including budget development and monitoring required. + Understanding of Medicare /Medicaid, Commercial insurance billing and reimbursement, and value-based ... they need with dignity, grace, and love. The **RN Director of Advanced Illness Management (AIM)** will report directly...will be eligible for:** + Competitive Pay + Medical, Dental , Vision Plans + Wellness Program and Resources including:… more
- Gilead Sciences, Inc. (Washington, DC)
- …advance policies relating to drug reimbursements, coverage and related issues impacting Medicare , Medicaid, and commercial insurance. Additional areas of focus ... 35 countries worldwide, with headquarters in Foster City, California. **Senior Director , Federal Government Affairs** **Job Overview:** Reporting to the Vice… more
- Teva Pharmaceuticals (Parsippany, NJ)
- Sr Director , Government Pricing & Reporting Date: Aug 30, 2024 Location: Parsippany, United States, New Jersey, 07054 Company: Teva Pharmaceuticals Job Id: 57437 ... and new people to make a difference with. **The opportunity** The Sr. Director , Government Pricing is responsible for the company's compliance with both the Federal… more
- Bon Secours Mercy Health (Richmond, VA)
- …sites and clinicians are recognized for clinical and operational excellence. ** Director , Large Accounts** **| Remote** This position is responsible for developing, ... contract management will range in revenues between $500m and $1b in commercial revenues. + Develops innovative, mutually beneficial economic and clinical alignment… more