- CVS Health (Salem, OR)
- …based (work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part ... encumbrances * Board Certified in ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals… more
- Humana (Columbus, OH)
- …analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides ... caring community and help us put health first** The Medical Director relies on medical ...or Surgery specialties + Utilization management experience in a medical management review organization, such as Medicare … 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 administration of physical and/or behavioral health… more
- Molina Healthcare (Long Beach, CA)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- AmeriHealth Caritas (Newtown Square, PA)
- …with the Vice President of Medicare Care Management and the Chief Medical Officer, the Corporate Director , Population Health Medicare Clinical Operations ... **Corporate Director , Population Health Clinical Operations, Medicare **... as well as throughout the enterprise to represent Medicare Medical Management interests. + Responsible for… more
- ChenMed (Memphis, TN)
- …preferred. + Strongly prefer one (1) years' previous experience as Medical Director or equivalent with a Medicare or Medicaid patient population + Board ... preferred. + Preferred to be an existing high performing PCP partner and/or Medical Director within the ChenMed core model, with a proven ability to manage a… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... home health per diem, DME, and waiver requests. The Medical Director provides medical interpretation... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify … more
- Humana (Columbus, OH)
- …a part of 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 Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Elevance Health (Columbus, OH)
- …deliver member-centered, lasting pharmacy care. In this pivotal role on our CarelonRx Medicare Sales and Account Management team, the Pharmacy Account Director ... preserving and deepening relationships with clients which include Elevance Health Medicare Health Plans. This position, structured around geographic regions and… more
- MyFlorida (Chattahoochee, FL)
- … and Fiscal Services. AMS - Work under the direction of the Ancillary Medical Services Director , with the Medicare /Medicaid Coder, Financial Services, ... fact finding research and reporting of various information, understanding Medicare /Medicaid practices and policy. Must be proficient in Excel...bills for review by Ancillary Medical Services Director and Medical Director prior… more
- Elevance Health (Columbus, OH)
- ** Director of Medicare Risk Adjustment Analytics and Reporting** **Location:** This position will work a hybrid model (remote and office). The ideal candidate ... will live within 50 miles of our Elevance Health PulsePoint locations. The ** Director of Medicare Risk Adjustment Analytics and Reporting** is responsible for… more
- CVS Health (Hartford, CT)
- …process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject ... Summary** Aetna, a CVS Health company has an outstanding opportunity for a Medical Director . Ready to take your career to the next level with a Fortune… more
- University of Miami (Miami, FL)
- …when necessary + Performs other duties as assigned by the Chief and/or clinic Medical Director + Experience with Medicare Advantage (65+) patient population ... evaluations. This role also works directly with staff, administration, medical directors, and other relevant stakeholders to assure appropriate...preferred + Completion of Medicare annual wellness exam documentation preferred + Knowledge of… more
- Elderwood (Buffalo, NY)
- …us support our commitment to providing exceptional care to our residents. Medical Billing Specialist ( Medicare /Managed Care) Position Overview: + Responsible for ... package, Life Insurance, Medical , Dental, and Vision insurance Responsibilities Medical Billing Specialist ( Medicare /Managed Care): + Review remittances for… more
- AdventHealth (Altamonte Springs, FL)
- …and State Medicaid programs, including changes affecting hospital reimbursement of Medicare bad debt, graduate medical education, disproportionate share hospital ... of work papers for the filing of the annual Medicare , Medicaid, and Champus/Tricare cost reports, audit preparation and...Complete special projects assigned by the department manager or director within the time frame requested **The expertise and… more
- Point32Health (Canton, MA)
- …are approved by senior leadership, the Senior Manager, in collaboration with the Director , is responsible for all necessary product filings with CMS and other ... business performance needs of each market. All responsibilities extend to any new Medicare markets should Point32Health choose to expand its footprint in the future.… more
- Trinity Health (Atlanta, GA)
- …follow up on overdue accounts and rejected claims. + Notify the Department Director or Manager as necessary regarding billing and claim processing. + Facilitate ... staff. + Maintain the integrity and confidentiality of patient financial and medical records. + Perform General Ledger Accounting duties, including journal entry and… more
- Elevance Health (Atlanta, GA)
- …objectives. + Collaborates with management to set strategic vision; oversees manager(s)/ director (s) with direct reports. + Hires, trains, coaches, counsels, and ... **Preferred Skills, Capabilities and Experiences** + Knowledge and understanding of Medicare rules and regulations for program areas including but not limited… 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 members of the ... Diploma, Associates degree; Bachelor's degree preferred + Certified Pharmacy Technician or Medical Assistant Certification desired + Third party Medical Billing… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
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