- Daiichi Sankyo, Inc. (Seattle, WA)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... areas centered around rare diseases and immune disorders. Summary: The Associate Director , Field Reimbursement (ADFR) is a critical front-line member of the DSI… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- About the Department The Clinical, Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... and developing and implementing regulatory strategies with the FDA to providing medical education and collecting data to support efficacy and new product… more
- Insmed Incorporated (Baton Rouge, LA)
- …of the field-based Field Access team, and will report to the Director , Field Access Managers. This is a non-supervisory position.ResponsibilitiesA key component of ... launch experience preferred Experience navigating payer reimbursement process, preferably Medicare Part D (pharmacy benefit design and coverage policy) Experience… more
- Elevance Health (Atlanta, GA)
- ** Medicare Medical Director ** Location: This position will work a hybrid model (remote and office). The ideal candidate will **must live** within 50 miles of ... one of our Elevance Health PulsePoint locations. The ** Medicare Medical Director ** is responsible for the administration of physical and/or behavioral health… more
- CVS Health (Salem, OR)
- …based (work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part ... encumbrances * Board Certified in ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals… 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. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… 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 ...or Surgery specialties + Utilization management experience in a medical management review organization, such as Medicare … more
- CVS Health (Hartford, CT)
- …process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject ... Summary** Aetna, a CVS Health company has an outstanding opportunity for a Medical Director . Ready to take your career to the next level with a Fortune… 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 + Must be… more
- Elevance Health (Cerritos, CA)
- … medical policy and Medicare Coverage Determinations. The **Associate Medical Director , Clinical Operations** is responsible for supporting the medical ... Benefits Management Medical Necessity Guidelines, client-specific health plan medical policy, state mandates/policies and Medicare determinations + Conduct… more
- Elevance Health (Columbus, OH)
- …deliver member-centered, lasting pharmacy care. In this pivotal role on our CarelonRx Medicare Sales and Account Management team, the Pharmacy Account Director ... preserving and deepening relationships with clients which include Elevance Health Medicare Health Plans. This position, structured around geographic regions and… more
- AdventHealth (Altamonte Springs, FL)
- …and 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 preparation and...Complete special projects assigned by the department manager or director within the time frame requested **The expertise and… more
- Point32Health (Canton, MA)
- …are approved by senior leadership, the Senior Manager, in collaboration with the Director , is responsible for all necessary product filings with CMS and other ... business performance needs of each market. All responsibilities extend to any new Medicare markets should Point32Health choose to expand its footprint in the future.… more
- Molina Healthcare (NM)
- …**Job Summary** Molina Pharmacy Services/Management staff work to ensure that Molina Medicare members have access to all medically necessary prescription drugs and ... therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics… more
- Providence (OR)
- …them._** **Providence Health Plan is calling an** HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA **who will:** + Perform internal coding audits of ... and prospective projects + Partner with the coding team, Supervisors, and Director to improve the accuracy, integrity, and quality of coding practices as… more
- Trinity Health (Atlanta, GA)
- …follow up on overdue accounts and rejected claims. + Notify the Department Director or Manager as necessary regarding billing and claim processing. + Facilitate ... staff. + Maintain the integrity and confidentiality of patient financial and medical records. + Perform General Ledger Accounting duties, including journal entry and… more
- Elevance Health (Atlanta, GA)
- …objectives. + Collaborates with management to set strategic vision; oversees manager(s)/ director (s) with direct reports. + Hires, trains, coaches, counsels, and ... **Preferred Skills, Capabilities and Experiences** + Knowledge and understanding of Medicare rules and regulations for program areas including but not limited… more
- The Cigna Group (Atlanta, GA)
- …& Solutions). Reporting to the Network Operations Senior Manager or Director , this individual ensures the effective performance management of the provider ... All market team members contribute to the growth and profitability of the Medicare Advantage business in their market in the following aspects: **Growing the MA… 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 ... home health per diem, DME, and waiver requests. The Medical Director provides medical interpretation... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify … more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... 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
