- ChenMed (Memphis, TN)
- …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
- MyFlorida (Chattahoochee, FL)
- …AMS - Work under the direction of the Ancillary Medical Services Director , with the Medicare / Medicaid Coder, Financial Services, Ancillary Services Staff ... fact finding research and reporting of various information, understanding Medicare / Medicaid practices and policy. Must be proficient...bills for review by Ancillary Medical Services Director and Medical Director prior… 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 ...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … 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....experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… 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 +… more
- Robert Half Legal (Alpharetta, GA)
- …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
- 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
- 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 ... 50 miles of our Elevance Health PulsePoint locations. The ** Director of Medicare Risk Adjustment Analytics and.... Experience with multiple risk adjustment models (MA, ACA, Medicaid ) and markets preferred . Familiarity with Star and… more
- 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
- Trinity Health (Atlanta, GA)
- …research and resolve payment discrepancies. + Experience in physician offices with Medicare / Medicaid exposure is a plus. **Position Highlights and Benefits:** + ... follow up on overdue accounts and rejected claims. + Notify the Department Director or Manager as necessary regarding billing and claim processing. + Facilitate… more
- 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
- 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 (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
- 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
- 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 ... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify ...to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel,… more
- 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
- Conviva (Tampa, FL)
- …a part of our caring community and help us put health first** The Associate Medical Director serves as a health-care professional and capable of handling a ... variety of health-related problems. The Associate Medical Director requires a solid understanding of...**Preferred Qualifications** + Active and unrestricted DEA license + Medicare Provider Number + Medicaid Provider Number… more
- 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
- Humana (Columbus, OH)
- …compliance with corrective action plans, as needed. Humana is seeking an Associate Director to oversee compliance programs for Humana's Medicaid contracts. The ... efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large.… more
- Aveanna (Atlanta, GA)
- …Assists RCM in billing issues as it relates to Medicare and Medicaid provider numbers * Assist Location Director , CNO/Compliance Department with information ... 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… more
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