- Humana (Washington, DC)
- …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 (Washington, DC)
- …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 (Washington, DC)
- **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 (Washington, DC)
- **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 (Washington, DC)
- **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 (Washington, DC)
- **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
- Evolent (Washington, DC)
- …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
- Humana (Washington, DC)
- …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 (Washington, DC)
- …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
- Evolent (Washington, DC)
- …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
- CVS Health (Washington, DC)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...and consistent responses to members and providers. As a Medical Director you will focus primarily on… more
- Evolent (Washington, DC)
- …$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
- Humana (Washington, DC)
- …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
- CenterWell (Washington, DC)
- …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
- Humana (Washington, DC)
- …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
- Baylor Scott & White Health (Washington, DC)
- …adjudicated claims data to uncover trends and assist in managing and understanding incurred medical and pharmacy cost. - The Director will design, develop, and ... Overview:** Reporting to the VP, Value-based Care Analytics, he Director of Healthcare Economics and Trend Analytics will support...Baylor Scott & White Quality Alliance Commercial, DTE, and Medicare (MSSP ACO, Medicare Advantage) lines of… more
- GRAIL (Washington, DC)
- …focusing on maximizing the impact through strategic interactions with the Centers for Medicare and Medicaid Services (CMS) and the CMS Coverage and Analysis Group ... Administrator, the Center for Clinical Standards and Quality (including the Chief Medical Officer and the vitally important Center for Coverage and Analysis), and… more
- Humana (Washington, DC)
- …a part of our caring community and help us put health first** The Director , Full Stack Engineering works with partners across the organization to build a digital ... cloud service delivery and the architecture of digital customer experiences. The Director , Full Stack Engineering requires an in-depth understanding of how digital… more
- CenterWell (Washington, DC)
- …of our caring community and help us put health first** The Director , Pharmaceutical Manufacturer Relations ensures the Pharmacy trade strategy aligns with ... formularies and the desired health outcomes of patients. The Director , Pharmaceutical Manufacturer Relations requires an in-depth understanding of how organization… more
- Humana (Washington, DC)
- …in the country. **Location:** remote The Insurance Strategy team supports Humana's Medicare and Medicaid lines of business. This business unit, Humana's largest, ... strategy for the business unit, evolving key dimensions of the Medicare Advantage growth strategy, developing a refreshed membership acquisition strategy, assessing… more