• Associate Market Clinical Director

    ChenMed (Richmond, VA)
    …years' previous experience as Medical Director or equivalent with a Medicare or Medicaid patient population + Board eligibility is required. + 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
    ChenMed (01/23/25)
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  • Manager, FP&A, Medicare / Medicaid

    CVS Health (Columbus, OH)
    …needed. Due to the nature of this remote role, candidates must have some Medicare and/or Medicaid experience. **Required Qualifications** -5 or more years of ... As the Manager, FP&A, you will report directly to Director of Finance and will monitor the end to...relevant financial experience - Medicare and/or Medicaid experience **Preferred Qualifications** -… more
    CVS Health (01/17/25)
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  • Director of Program Integrity…

    Robert Half Legal (Albany, NY)
    …professional to strengthen our team. This role will primarily focus on healthcare Medicaid HIPAA compliance. The Director of Program Integrity will be ... (CRCM) to enhance compliance processes. * Leverage expertise in Health Care Audits - Medicare - Medicaid to improve operations and compliance. * Utilize strong… more
    Robert Half Legal (12/13/24)
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  • Medicare Grievances and Appeals Corporate…

    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. The ... Corporate Medical Director works on problems of diverse scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products +… more
    Humana (01/07/25)
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  • Medicare Advantage Provider Operations…

    The Cigna Group (Bloomfield, CT)
    …for the right candidate.** Ability to travel up to 25%.** **OVERVIEW:** The Medicare Advantage (MA) Provider Operations Senior Director is a senior leadership ... team meets all deliverables and milestones supporting the Annual Readiness process for Medicare and Medicaid . + Review MA Provider Operations systems and… more
    The Cigna Group (01/23/25)
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  • Senior Director Medicare Ops

    Banner Health (AZ)
    …between BUHP and BPHSO. This position will have a direct interface with the Arizona Medicaid Agency (AHCCCS), Center of Medicare and Medicaid Services (CMS), ... including marketing, government programs, member retention, network administration, and medical management administration departments. Responsible for ensuring cross-organizational collaboration… more
    Banner Health (12/15/24)
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  • Finance Medicare Reimbursement Analyst

    AdventHealth (Altamonte Springs, FL)
    …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...Complete special projects assigned by the department manager or director within the time frame requested **The expertise and… more
    AdventHealth (12/14/24)
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  • Medicare D Billing Representative

    BrightSpring Health Services (Arlington, TX)
    …on outstanding claims + Individual with an understanding of Insurance and Medicaid formularies and processes including the prior authorization processes + Makes ... 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… more
    BrightSpring Health Services (12/24/24)
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  • Medical Director --Claims Management

    Humana (Columbus, OH)
    …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... caring community and help us put health first** The Medical Director actively uses their medical...a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health… more
    Humana (10/29/24)
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  • Medical Director - Mid West Region

    Humana (Columbus, OH)
    …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... caring community and help us put health first** The Medical Director actively uses their medical...a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health… more
    Humana (10/29/24)
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  • Medical Director - Gulf South

    Humana (Columbus, OH)
    …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... caring community and help us put health first** The Medical Director relies on medical ...a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health… more
    Humana (12/03/24)
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  • Medical Director - Medical

    CVS Health (Sacramento, CA)
    …and/or medical necessity appeals for commercial clients, governmental ( Medicare / Medicaid ) programs and individual client requested coverage determinations or ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs.... medical necessity appeals for commercial clients, governmental ( Medicare / Medicaid ) programs and individual client requested coverage… more
    CVS Health (01/04/25)
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  • Director , Corporate Reimbursement…

    RWJBarnabas Health (Oceanport, NJ)
    … will serve as a key resource to department leadership for providing Medicare and Medicaid reimbursement support and implementing government payment strategies ... Health hospitals. This includes planning, preparing and reviewing of the annual Medicare / Medicaid cost reports filings. In partnership with the Vice President… more
    RWJBarnabas Health (12/21/24)
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  • Director , Net Revenue

    Beth Israel Lahey Health (Charlestown, MA)
    …and AVP, the Director will develop long- and short- term Medicare , Medicaid , and other government reimbursement revenue strategies, oversee preparation and ... job, you're making a difference in people's lives.** The Director , Revenue Finance and Reimbursement, will be a core...both government and commercial payment systems; and, (4) Provide Medicare , Medicaid , and payment system expertise in… more
    Beth Israel Lahey Health (12/10/24)
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  • Associate Medical Director

    Lancaster General Health (Lancaster, PA)
    **Summary** **Job Description** **POSITION SUMMARY:** The Associate Medical Director , Hospitalist Services is responsible for assisting the Medical ... The Associate director will report to LGHP Medical Director and have a reporting relationship...+ A health care provider in good standing with Medicare , Medicaid , and other federal and state… more
    Lancaster General Health (01/12/25)
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  • Assistant Service Line Medical

    Marshfield Clinic (Eau Claire, WI)
    …most exciting missions in the world!** **Job Title:** Assistant Service Line Medical Director - Hematology/Oncology **Cost Center:** 301081251 Systems Operations ... **Time Type:** Part time **Job Description:** **POSITION TITLE:** Assistant Service Line Medical Director for Hematology/Oncology **REPORTS TO:** Service Line … more
    Marshfield Clinic (12/15/24)
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  • Medical Director

    Molina Healthcare (Columbus, OH)
    …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....experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (01/21/25)
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  • Medical Director (Based in SC)

    Molina Healthcare (Charleston, SC)
    …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....experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (01/18/25)
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  • Director , Medical Regulatory…

    Corewell Health (Grand Rapids, MI)
    …compliance with regulatory and accreditation requirements and to ensure Medicare , Medicaid and NCQA audit readiness for the Medical Management department. ... Job Summary - Director , Medical Regulatory and Accreditation Collaborates...operations for compliance with regulatory and accreditation requirements including Medicare , Medicaid , National Committee on Quality Assurance… more
    Corewell Health (01/22/25)
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  • Medical Director - Clinical Services

    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: Non-Supervisory Exemption Status: Exempt...the Quadruple Aim. Direct support may be focused on Medicaid or Medicare lines of business in… more
    CareOregon (12/06/24)
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