- Highmark Health (Augusta, ME)
- …current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and ... **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions,… more
- Humana (Augusta, ME)
- …help us put health first** Humana Healthy Horizons is seeking an Associate Director , Medicaid Implementation (Business Project Management) to lead within a ... management are best suited for this role. The Associate Director , Medicaid Implementation (Business Project Management) will...Up to 25% to Humana office locations. + **Workstyle:** Remote , must work hours within the eastern time zone.… more
- Conviva (Augusta, ME)
- …of our caring community and help us put health first** The Associate Director , Security Architecture will play a key role in implementing security architecture, ... ensure the enterprise can achieve the enterprise security strategy. The Associate Director , Security Architecture will play a key role in implementing security… more
- Humana (Augusta, ME)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Augusta, ME)
- …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...+ Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate… more
- Cardinal Health (Augusta, ME)
- …and Medicaid , including duplicate discounts, fee-for-service versus managed care, medical versus pharmacy, and entity-owned versus contract pharmacy settings + A ... an individual contributor role that reports to the Sr. Director of Clinical Operations. Candidates can live anywhere in...they navigate HRSA 340B audits. This support typically is remote but may require travel to the client location.… more
- Public Consulting Group (Augusta, ME)
- …intersection and overlap between our Special Education/Case Management and school-based Medicaid services work within a state; regularly engage with counterparts + ... clients + Understand and continually monitor Federal, state, and local Medicaid School-Based program policies and guidance, collaborating with PCG subject matter… more
- Public Consulting Group (Augusta, ME)
- …individual will support the public safety consulting business line, and other Medicaid and Medicare related projects. This role will use knowledge of fire/emergency ... medical services (EMS) standards, practical and clinical experience, and...departments and/or EMS agencies at the chief officer or manager/ director level. Provenexperience with people management, strategic planning, risk… more
- Public Consulting Group (Augusta, ME)
- …support the delivery of health-related services by helping schools access critical Medicaid reimbursement. Client Success Partners (CSP) are key members of the ... PCG services. This position may report to either a SBS COE Client Success Director or a Client Success Lead. **Duties and Responsibilities** _Clients_ + Own and… more
- Humana (Augusta, ME)
- …for one of the leading healthcare organizations. Reporting to the Associate Director of our Experience Team and partnering with Architecture and Product teams, ... official application on Humana's secure website. _*This is a remote position._ _**Must be able to work 8am-5pm EST...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- State of Maine, Bureau of Human Resources (Augusta, ME)
- …Auditor I Augusta , Maine , United States | Auditor | Full-time | Partially remote Apply by: Nov. 27, 2024 Apply with Linkedin Apply Department of Health and Human ... to grow personally and professionally as you acquire knowledge of Medicare, Medicaid , and Federal grants. REQUIREMENTS: To qualify, you must have: + Six… more