• Associate Market Clinical Director

    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
    ChenMed (11/23/24)
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  • Operations Analyst II

    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
    MyFlorida (11/20/24)
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  • Medical Director - National…

    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
    Humana (11/08/24)
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  • Medical Director - Medicare

    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
    Molina Healthcare (11/21/24)
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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 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
    Humana (10/29/24)
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  • Director of Program Integrity…

    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
    Robert Half Legal (11/07/24)
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  • Corporate Director , Population Health…

    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
    AmeriHealth Caritas (11/19/24)
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  • Director of Medicare Risk Adjustment…

    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
    Elevance Health (11/21/24)
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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 (11/20/24)
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  • Medicare Biller

    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
    Trinity Health (10/30/24)
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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 (11/23/24)
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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 - 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 (11/22/24)
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  • Medical Director - Home Health…

    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
    Humana (11/06/24)
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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 (10/14/24)
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  • Associate Medical Director

    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
    Conviva (10/29/24)
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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 (09/29/24)
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  • Associate Director , Compliance

    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
    Humana (11/21/24)
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  • Director , Regulatory Licensing

    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
    Aveanna (11/26/24)
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