- Elevance Health (Chicago, IL)
- …plan medical policy and Medicare Coverage Determinations. The **Associate Medical Director , Clinical Operations** is responsible for supporting the ... reviews of high-tech diagnostic imaging, cardiac testing and sleep management services. Medical Directors in Clinical Operations determine the medical … 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 ...hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management. + Prefer Medical … more
- Elevance Health (Columbus, OH)
- ** Medicare Medical Director ** Location:...Director Associates. May be responsible for an entire clinical program. **How you will make an impact:** + ... be able to work Eastern Time Zone hours. The ** Medicare Medical Director ** is responsible...external committees. + May chair company committees. + Interprets medical policies and clinical guidelines. + May… 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 ... of experience in a Health Care Delivery System eg, Clinical Practice or Health Care Industry * Medical...* Board Certified in ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance &… more
- Molina Healthcare (San Bernardino, CA)
- …NCQA-compliant clinical 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 … more
- Cleveland Clinic (Cleveland, OH)
- Director Medicare Coverage Analysis Join Cleveland Clinic's Main Campus where research and surgery are advanced, technology is leading-edge, patient care is ... on FDA and Medicare regulations and state laws that apply to clinical trials research billing and trains MCA analysts. + Generate policies and procedures related… 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. The ... Corporate Medical Director works on problems of diverse scope and complexity...+ Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry… more
- UCLA Health (Los Angeles, CA)
- …of the Medicare Advantage Risk Adjustment leadership team, the Assistant Director of Risk Adjustment is instrumental in participating in the planning with the ... director and other functional areas for implementation and execution...throughout Southern California. We're also home to the world-class medical research and clinical education capabilities of… more
- CVS Health (Blue Bell, PA)
- …that develops, analyzes, and reports on formulary strategies, manufacturer rebate value, and clinical programs - all with an eye toward optimizing the cost structure ... Act as a subject matter expert on Part D formularies, rebate structures, clinical program value, and integrate team's results with work performed by others,… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …providing analytic support to help identify the most efficient means through which Medicare Stars clinical quality and patient experience performances at BCBSMA ... into a cohesive view. Under direction of the Senior Director of Population Health Analytics, the Data Scientist will...to track performance trending of patient access to care, clinical quality and consumer experience among Medicare … 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 ... timelines. The Senior Manager works closely with claims, membership operations, clinical services, care management, customer relations, sales, marketing, and other… more
- BlueCross BlueShield of North Carolina (NC)
- …according to regulatory requirements. + Assess appropriateness for secondary case review by the Medical Director (MD) for denials and coordinate as needed. + May ... **Job Description** The Episodic Care Manager- Medicare Advantage is responsible for performing clinical...delivery of health care services for members based on medical necessity and contractual benefits. Effectively coordinate with providers,… more
- CareOregon (Portland, OR)
- Position Title: Medical Director - Clinical Services Requisition #: 24590 Department: Department: Medical Management Administration Title of Manager: Sr ... Medical Director - Clinical Services Supervises: Non-Supervisory Exemption...Aim. Direct support may be focused on Medicaid or Medicare lines of business in a Coordinated Care Organization… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …(HCMC) is seeking a highly motivated individual for a full-time on-site opportunity as Medical Director of Clinical Chemistry and Point-of-Care Testing. This ... moderate and lower complexity laboratories. This individual will work collaboratively with an Associate Medical Director of Clinical Chemistry as part of a… more
- BrightSpring Health Services (Arlington, TX)
- …+ Achieves productivity goals with regard to calls/claims per hour as determined by the Director and Clinical Hub Manager + Provide clinical support to ... This vital role serves as a key point of contact for the Clinical Hub and proactively communicates with Pharmacists, Facilities, Physicians and PDP's regarding… more
- UHS (Johnson City, NY)
- Director Clinical Pathology (Phyisican), UHS Wilson Medical Center United Health Services is seeking a Director Clinical Pathology (Phyisican) to ... join our WMC Pathology 04 department at UHS Wilson Medical Center in Johnson City, NY. This position is...Hours per week: 40 Salary range: Depends on Experience Director Clinical Pathology (Phyisican) / Overview The… more
- Trinity Health (Columbus, OH)
- …! **About the job:** At the direction of the Regional Vice President of Clinical Quality, the Regional Director of Clinical Quality is responsible ... providing overall vision and direction for all aspects of clinical quality. The Regional Director ensures that...Commission standards and other regulatory standards related to hospital clinical quality metrics and medical staff ongoing… more
- Elara Caring (Bronx, NY)
- …professionals, providing the Right Care, at the Right Time, in the Right Place. ** Director Clinical Strategy and Initiatives, Home Care** At Elara Caring, we ... have countless ways to make a difference as a Director Clinical Strategy and Initiatives, Home Care...+ Opportunities for advancement + Comprehensive insurance plans for medical , dental, and vision benefits + 401(K) with employer… more
- ChenMed (New Orleans, LA)
- …preferred. + Strongly prefer one (1) years' previous experience as Medical Director or equivalent with a Medicare or Medicaid patient population + Board ... great people to join our team. The Associate Market Clinical Director will directly supervise, performance manage...to be an existing high performing PCP partner and/or Medical Director within the ChenMed core model,… more
- Elara Caring (Greenville, TX)
- …at the Right Time, in the Right Place. **Job Description:** The Area Director of Clinical Operations is responsible for precepting, developing, and training ... new Registered Nurse and Clinical Manager team members. The Area Director ...advanced clinical skills as defined by accepted clinical standards. + Working knowledge of Medicare ,… more
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