• South Peninsula Hospital (Homer, AK)
    …SPH recently obtained a 5 Star Patient Satisfaction rating through CMS (Centers of Medicare & Medicaid Services). Homer, Alaska, is a small, charming seaside ... operations of a healthcare system? As the Revenue Cycle Director , you'll have the unique opportunity to drive revenue...score above the state and national average in the Medicare Hospital Compare patient satisfaction and quality scores and… more
    job goal (12/25/25)
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  • The Goodkind Group, LLC (Melville, LA)
    …three (3) years of Insurance Follow-up, multi-specialty experience, and knowledge of Medicare , Medicaid and Government HMO insurance follow-up. As the Supervisor ... Insurance Follow-up Supervisor to work for a rapidly growing medical management company in the Farmingdale/Melville area. This position...- Insurance follow-up you will act as liaison between departments, director , management and… more
    job goal (12/23/25)
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  • Associate Market Medical 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 (10/21/25)
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  • Medicare / Medicaid Claims Editing…

    Commonwealth Care Alliance (Boston, MA)
    …have):** + 7+ years of Healthcare experience, specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical ... operations, health care reimbursement, public health care programs and reimbursement methodologies ( Medicaid and Medicare ) + Medical Coding, Compliance,… more
    Commonwealth Care Alliance (11/25/25)
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  • Senior Medicaid & Medicare

    OhioHealth (Columbus, OH)
    …**Job Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This ... position will be responsible for ensuring the appropriate governmental ( Medicare and Medicaid ) reimbursement is received for OhioHealth. * This position is… more
    OhioHealth (12/25/25)
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  • Medical Director - Medicaid

    Humana (Baton Rouge, LA)
    …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 (12/07/25)
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  • Medical Director , Medicare

    Humana (Honolulu, HI)
    …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 (11/19/25)
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  • Medicaid Contract Implementation Management…

    Elevance Health (Indianapolis, IN)
    ** Medicaid Contract Implementation Management Director ** **Location** : Indianapolis, IN **Hybrid 2:** This role requires associates to be in-office 3 days per ... for employment, unless an accommodation is granted as required by law._ The ** Medicaid Contract Implementation Management Director ** is responsible for managing … more
    Elevance Health (12/19/25)
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  • Associate Director , Product Marketing…

    Humana (Albany, NY)
    …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... put health first** Humana's Marketing organization is seeking an Associate Director , Product Marketing to lead the go-to-market, positioning, and member-focused… more
    Humana (12/23/25)
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  • Oklahoma Medicaid Market CFO

    Humana (Oklahoma City, OK)
    …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... part of our caring community and help us put health first** The Oklahoma Medicaid Market CFO analyzes and forecasts financial, economic, and other data to provide… more
    Humana (11/19/25)
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  • Medicare Sales Field Agent - CarePlus…

    Humana (Sanford, FL)
    …Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare , or both Medicare and Medicaid , achieve their best possible ... under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
    Humana (12/10/25)
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  • Medicare Long Term Services & Support Care…

    AmeriHealth Caritas (Detroit, MI)
    …and authorizations, including home- and community-based programs. + Collaborate with the Medical Director and care team to develop and monitor treatment ... Medicare LTSS Care Coordinator manages care coordination for Medicare beneficiaries with complex medical , behavioral health,...role ensures that care is delivered by Centers for Medicare & Medicaid Services (CMS), state, and… more
    AmeriHealth Caritas (11/18/25)
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  • System Manager Revenue Cycle ( Medicare

    Houston Methodist (Katy, TX)
    …needed to ensure operational billing compliance with government/regulatory agencies and the Medicare and Medicaid programs. + Ensures optimization of timely cash ... Inpatient/ Outpatient Prospective Payment Systems, etc. + Stays informed of the latest Medicare , Medicaid and commercial payor news, updates, and regulations and… more
    Houston Methodist (11/12/25)
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  • Medical Director - IP Claims…

    Humana (Raleigh, NC)
    …teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicare Advantage, and Medicaid requirements and will ... caring community and help us put health first** The Medical Director actively uses their medical...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical more
    Humana (12/11/25)
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  • Medical Director -Payment Integrity

    Humana (Carson City, NV)
    …clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare , Medicaid , and ... caring community and help us put health first** The Medical Director actively uses their medical...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical more
    Humana (12/11/25)
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  • Medical Director - OneHome

    Humana (Harrisburg, PA)
    …SNF, DME, dual Medicare / Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services ... help us put health first** The Medical Director relies on fundamentals of CMS Medicare ...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
    Humana (12/18/25)
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  • OneHome - Medical Director - Part…

    Humana (Charleston, WV)
    …SNF, DME, dual Medicare / Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services ... help us put health first** The Medical Director relies on fundamentals of CMS Medicare ...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
    Humana (11/27/25)
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  • Medical Director - Pharmacy Appeals

    Humana (Lincoln, NE)
    …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... of the Medicare rules, Humana policies and medical necessity. The Medical Director ...a medical management review organization such as Medicare Advantage, managed Medicaid , or Commercial health… more
    Humana (12/03/25)
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  • Medical Director - Nat'l IP UM Team

    Humana (Jefferson City, MO)
    …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 (11/15/25)
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  • Utilization Review Medical Director

    Integra Partners (Troy, MI)
    Director ensures determinations are made in accordance with Medicare and Medicaid guidelines, health plan-specific criteria, internal policies, and ... The Utilization Review Medical Director is responsible for conducting...alignment or operational workflows. + Maintain up-to-date knowledge of Medicare , Medicaid , DMEPOS policies, clinical standards of… more
    Integra Partners (12/02/25)
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