• Medical Director - National

    Humana (Phoenix, AZ)
    …or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical ... 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
    Humana (11/08/24)
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  • Medical Director - Medicare

    CVS Health (Phoenix, AZ)
    …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 ... 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...* Board Certified in ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance &… more
    CVS Health (10/31/24)
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  • Senior Director Medicare Ops

    Banner Health (AZ)
    …government programs, member retention, network administration, and medical management administration departments. Responsible for ensuring cross-organizational ... a direct interface with the Arizona Medicaid Agency (AHCCCS), Center of Medicare and Medicaid Services (CMS), Association for Community Affiliated Plans (ACAP), and… more
    Banner Health (12/15/24)
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  • Medical Director - OneHome/Home…

    Humana (Phoenix, AZ)
    …and help us put health first** Job Description Summary The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing ... provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify … more
    Humana (12/21/24)
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  • Medical Director - Mid West Region

    Humana (Phoenix, AZ)
    **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... 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 (10/29/24)
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  • Medical Director - Florida

    Humana (Phoenix, AZ)
    **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
    Humana (12/14/24)
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  • Reviewing Medical Director

    Conviva (Phoenix, AZ)
    **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
    Conviva (12/11/24)
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  • Medical Director --Claims Management

    Humana (Phoenix, AZ)
    **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
    Humana (10/29/24)
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  • Associate Medical Director

    CenterWell (Mesa, AZ)
    …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 + Minimum… more
    CenterWell (12/24/24)
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  • Field Medical Director , Cardiology

    Evolent (Phoenix, AZ)
    …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
    Evolent (11/15/24)
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  • Director , Market Finance

    Humana (Phoenix, AZ)
    …a part of our caring community and help us put health first** The Director , Market Finance is a financial leadership position with a significant focus on strategy ... and operations. The Director , Market Finance requires an in-depth understanding of how...work closely with the RVP, Operations, including exposure to Medicare Advantage bid strategy, regional operations staffing, and administrative… more
    Humana (12/19/24)
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  • Corporate Medical Director

    Humana (Phoenix, AZ)
    …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 (11/27/24)
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  • Field Medical Director -General…

    Evolent (Phoenix, AZ)
    …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , you will be a key member of the utilization management team. ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
    Evolent (12/09/24)
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  • Managing Director , Value Based Care…

    Evolent (Phoenix, AZ)
    …$64M of savings for Medicare in the Shared Savings Program. The Managing Director will report to the SVP Primary Care / President of Evolent Care Partners and ... Medicare and Commercial contracts, including plans related to medical expense management, quality improvement, appropriate risk adjustment, and patient and… more
    Evolent (12/13/24)
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  • Director of Graduate Medical

    Community Health Systems (Tucson, AZ)
    …of operational, financial, programmatic and personnel activities for GME and Medical Staff Administration working with the GME programs. This includes establishing, ... records necessary for GME reimbursement as mandated by the Center for Medicare and Medicaid Services (CMS) * Represent the organization at professional conferences… more
    Community Health Systems (12/10/24)
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  • Director Quality & Risk Mgmt - FT Days

    LifePoint Health (Bullhead City, AZ)
    …in good standing. Multi-State Licensure accepted. **Job:** **Quality* **Organization:** **Valley View Medical Center* **Title:** * Director Quality & Risk Mgmt - ... are not just what you can do. Valley View Medical Center is a state-of-the-art hospital, licensed with 52...Growth Opportunities * And much more *Position Summary: The Director of Quality and Risk Management provides comprehensive assessment,… more
    LifePoint Health (11/26/24)
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  • Director , Claims Recovery Unit

    Banner Health (AZ)
    …experience with 1500 and UB claims auditing, analyzing and researching medical records; knowledge of Medicare /Medicaid reimbursement guidelines including MS-DRG ... in health care, Banner Plans & Networks (BPN) integrates Medicare and private health plans to reduce healthcare costs...by offering remote and hybrid work settings. As a Director , Claims Recovery Unit, you will lead a small… more
    Banner Health (12/18/24)
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  • Associate Director , Actuarial

    Humana (Phoenix, AZ)
    …of our caring community and help us put health first** The Associate Director , Actuarial provides actuarial support across a broad range of actuarial and business ... needs for specific product lines. The Associate Director , Actuarial requires a solid understanding of how organization capabilities interrelate across department(s).… more
    Humana (12/12/24)
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  • Director , Complex Care Strategy…

    CenterWell (Phoenix, AZ)
    …a part of our caring community and help us put health first** The Director , Complex Care Strategy Advancement will play a pivotal role in driving the strategic ... quality and cost improvement for high-risk senior populations in full risk Medicare arrangements. This individual will be responsible for assessing the value of… more
    CenterWell (12/10/24)
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  • Associate Director Cloud Architecture

    Humana (Phoenix, AZ)
    …our caring community and help us put health first** The Associate Director , Cloud Architecture designs, builds, and maintains data processing architectures and ... and unstructured data to insights at enterprise scale. The Associate Director , Cloud Architecture requires an in-depth understanding of how organization capabilities… more
    Humana (11/02/24)
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