- City of New York (New York, NY)
- …is recruiting for one (1) Administrative Manager NM-III, to function as the Executive Director , of the Office of Mail Renewal, Managed Care Program (MCP), and ... with other agencies such as the NY State Department of Health (SDOH), NY Medicaid CHOICE/MAXIMUS, Managed Care Organizations (MCOs), the Office of Medicaid … more
- Highmark Health (Columbus, OH)
- …the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In ... for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure… more
- Elevance Health (Overland Park, KS)
- **Kansas Medicaid Compliance Consultant Senior** **Location: Must be located in/a resident of Kansas** This position will take part in Elevance Health's hybrid ... state of Kansas. This includes working closely with the Compliance Director and Manager around complaint resolution...and enforcement of those requirements and owns the Kansas Medicaid Compliance Committee. + Supports business development… more
- VNS Health (Manhattan, NY)
- OverviewEmbark on a dynamic journey as the Medical Director at VNS Health Plans, where every day brings new challenges and opportunities to make a difference in ... concerning medical services for Health Plan members. + Ensures compliance with relevant and applicable federal, state and local...on issues related to Fraud, Waste, and Abuse of Medicare/ Medicaid services. + Ensures that Health Plan and program… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Senior Director , Third Party Compliance Oversight reports directly to the SVP, Corporate Compliance & Ethics and ... . + Works closely with the Governance, Risk & Compliance (GRC) teams (Medicare, Medicaid , Privacy, Fraud,...Strong acumen and understanding of healthcare, health insurance and managed health care industries and organizations required. + Strong… more
- Humana (Columbus, OH)
- …Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, ... experience in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance + Experience with national… more
- University of Colorado (Aurora, CO)
- CU Medicine Family Medicine - Louisville Medical Director Open Rank -Senior Instructor Series - 34358 Faculty **Description** **University of Colorado Anschutz ... Medicine** **Job Title:** **CU Medicine Family Medicine - Louisville Medical Director ** **Open Rank -Senior Instructor Series** **Position #00825042 - Requisition… more
- State of Massachusetts (Boston, MA)
- …is led by the Director of Program Integrity, who reports to the Deputy Medicaid Director , and consists of 10 internal staff members and dozens of contractors ... Deputy Director has two primary responsibilities: 1) ensuring that Managed Care Organizations who contract with MassHealth are appropriately utilizing state… more
- CVS Health (Harrisburg, PA)
- …more personal, convenient and affordable. **Position Summary** Aetna Better Health is Aetna's Medicaid managed care plan. Backed by over 30 years of experience ... to bring accessible healthcare to our members. The LTSS Director , Clinical Health Services ( Director ), will partner...Medicaid LTSS leadership **Required** + 10+ Years of Managed Care experience preferred **Education** + If RN -… more
- Humana (Columbus, OH)
- …Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, ... experience in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national… more
- CVS Health (Columbus, OH)
- …(eg, specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance , Legal, Accreditation) and clients. The Medical Director ... (eg, specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance , Legal, Accreditation) and clients. The Medical Director … more
- Humana (Columbus, OH)
- …Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid , or other Medical management organizations, hospitals/ Integrated ... in a medical management review organization, such as Medicare Advantage and managed Medicaid + Physical Medicine and Rehabilitation, Internal Medicine, Family… more
- Humana (Columbus, OH)
- …Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, ... experience in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national… more
- University of Colorado (Aurora, CO)
- Medical Director Department of Family Medicine Innovation Practice - Open Rank - 31241 Faculty **Description** **University of Colorado | CU Anschutz Medical ... Medicine | Department of Family Medicine** **Family Physician -** **Medical Director Department of Family Medicine Innovation Practice** **Open Rank -Senior… more
- CVS Health (Irving, TX)
- …your career goals.** **Position Summary** : The Medicaid Network State Director manages and oversees compliance with our Network responsibilities as provided ... Affordability Targeted Improvements as identified. * The State Network Director will manage and deploy the Medicaid ...the recruitment of new providers as needed and maintain compliance with all network access requirements. * Assist and… more
- Organon & Co. (Bloomington, IN)
- …or collaborative Women's Health point of contact for Organon for the following: + State Medicaid & Managed Medicaid Plans + State FQHCs Administration and ... **Job Description** **The Position** Under the guidance of the Director , Commercial Operations - Women's Health, the Women's Health Account Director (WH-AD) is… more
- CareOregon (Portland, OR)
- … Medicaid , Medicare, and commercial insurance + Understanding of managed care operations + Familiarity with guideline development, outcomes management, population ... comply with all federal laws. Job Title Associate Medical Director - Maternal, Child, and Youth Department Medical Management...the Quadruple Aim. Direct support may be focused on Medicaid , Medicare, or Maternal, Child, and Youth Strategy lines… more
- Point32Health (Canton, MA)
- …exchange, Medicaid and Medicare products required. + Experience in managed care systems required. + Ideal candidate will have extensive, relevant inpatient ... at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director , Utilization Management is responsible for directing, leading, and… more
- Aveanna (Atlanta, GA)
- …relates to Medicare and Medicaid provider numbers * Assist Location Director , CNO/ Compliance Department with information necessary to comply with state ... Director , Regulatory Licensing ApplyRefer a FriendBack Job Details...achieving results. Responsible and leads key projects related to licensing/Medicare/ Medicaid processes, adverse sanctions, and disclosures of ownership related… more
- Bayer (Germantown, TN)
- …to Bayer Programs/Therapies); + Govt, National and local Commercial Payer experience, State Medicaid , and Managed Plans; + Experience in educating and supporting ... this knowledge to address individual customer concerns; + Broad knowledge of Medicare, managed care, third party payers and Medicaid ; + Demonstrated excellence… more