• Tris Pharma (Monmouth Junction, NJ)
    …knowledge of government pricing regulations including MDRP (Medicaid Drug Rebate Program), Medicare Part D, 340B, and VA Federal Supply Schedule; understanding ... have an opening in our Monmouth Junction, NJ facility for a Director , Market Access, OperationsThis position is responsible for managing the operational… more
    HireLifeScience (12/09/25)
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  • Lundbeck (Los Angeles, CA)
    …within the region boundary Injectable/infusion sales experience within a buy & bill Medicare Part B/ Medical benefit environment or other comparable ... CO, NV, TX, OR and other western states) SUMMARY: The Regional Business Director (RBD) is responsible for leading field-based Area Sales Managers (ASM) and… more
    HireLifeScience (12/06/25)
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  • USAA (Colorado Springs, CO)
    …loyalty and service - define how we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity USAA is seeking a ... talented Director , Retirement Income to lead multiple teams of Health,...Risk and Compliance on interpretation of CMS (Center for Medicare and Medicaid Services) rules to provide guidance and… more
    job goal (12/10/25)
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  • CenterWell Home Health (Pittsfield, MA)
    Become a part of our caring community and help us put health first Work Schedule Full-time/40 Hours Position Type On-site Branch Location Pittsfield, MA This is not ... final audits/billing are completed timely and in compliance with Medicare regulations. Coordinates communication between team members/attending physicians/caregivers to… more
    job goal (12/14/25)
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  • Christus Health (Los Alamos, NM)
    …interviews patients, obtain accurate demographic and financial information and check for medical necessity for all Medicare patients. Computer entry, preparing ... verbally in English. Laboratory equipment operation skills required. Knowledge of medical terminology. EXPERIENCE: Minimum of two years as a Lab Assistant… more
    JobLookup XML (12/11/25)
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  • Medical Director , Nat'l OP…

    Humana (Providence, RI)
    …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests for ... services. The Medical Director work assignments involve moderately complex...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
    Humana (12/13/25)
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  • Medical Director - Medicare

    CVS Health (Hartford, CT)
    …the US. **Responsibilities of this Medical Director role are related to Medicare Appeals:** * Direct daily work on part C appeals (both provider and ... * Provide direct support to appeal nurses and dedicated Medicare part D pharmacists; supervision and participation...in ABMS or AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance &… more
    CVS Health (12/03/25)
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  • Medical Director , Medicare

    Humana (Honolulu, HI)
    **Become 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 + Possess analysis… more
    Humana (11/19/25)
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  • Senior Medicaid & Medicare Reimbursement…

    OhioHealth (Columbus, OH)
    …matter expert in the following areas, S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, Indirect Medical Education, Graduate Medical ... belief system.** We believe wellness and sickness are both part of a lifelong partnership, and that everyone could...This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities.… more
    OhioHealth (09/25/25)
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  • Medicare Sales Field Agent - CarePlus…

    Humana (Sanford, FL)
    …must live in the designated territory to effectively serve their local community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work ... **Become a part of our caring community and help us...The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role,… more
    Humana (12/10/25)
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  • Medicare Billing Specialist- Onsite

    Community Health Systems (La Follette, TN)
    …+ 1-2 years of experience in understanding the minimum requirements needed for Medicare billing, medical claims processing, or hospital revenue cycle operations ... **Job Summary** The Medicare Billing Specialist is responsible for performing timely...physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the… more
    Community Health Systems (12/09/25)
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  • OneHome - Medical Director

    Humana (Charleston, WV)
    **Become a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following ... SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided… more
    Humana (11/27/25)
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  • PCO Medical Director - UM…

    CenterWell (Annapolis, MD)
    …a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health claims. ... The Medical Director , Primary Care work assignments involve moderately complex to...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
    CenterWell (11/06/25)
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  • Medical Director - OneHome

    Humana (Boise, ID)
    **Become a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following ... SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided… more
    Humana (11/27/25)
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  • Medical Director - Pharmacy Appeals

    Humana (Lincoln, NE)
    …to review Medicare drug appeals ( Part D & B). The Medical director work assignments involve moderately complex to complex issues where the analysis ... of the Medicare rules, Humana policies and medical necessity. The Medical Director ...Pharmacy Policies and Procedures, and clinical literature as appropriate. Medical Directors will learn Medicare Part more
    Humana (12/03/25)
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  • Medical Director - IP Claims…

    Humana (Raleigh, NC)
    …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to ... 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
    Humana (12/11/25)
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  • Medical Director -Payment Integrity

    Humana (Carson City, NV)
    …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to ... 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
    Humana (12/11/25)
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  • Medical Director - Nat'l IP UM Team

    Humana (Jefferson City, MO)
    …a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… more
    Humana (11/15/25)
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  • Medical Director - Medicaid N.…

    Humana (Indianapolis, IN)
    **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...group practice management. + Utilization management experience in a medical management review organization, such as Medicare more
    Humana (10/25/25)
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  • Associate Medical Director

    CenterWell (Las Vegas, NV)
    …the lives of our patients, and the healthcare industry as a whole. The Associate Medical Director serves as a health-care professional and capable of handling a ... **Become a part of our caring community and help us...variety of health-related problems. The Associate Medical Director requires a solid understanding of… more
    CenterWell (10/29/25)
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