- Humana (Austin, TX)
- …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
- CVS Health (Austin, TX)
- …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
- Humana (Austin, TX)
- …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
- Humana (Austin, TX)
- …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 ... 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 (Austin, TX)
- **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 (Austin, TX)
- **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 (Austin, TX)
- **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
- Ascension Health (Austin, TX)
- …**Schedule** :TBA + **Practice** **Detail** : Ascension Texas has an immediate opening for a Medical Director of Population Health who will serve as a member of ... We are seeking to recruit a full time, practicing Medical Director of Population Health to serve...Care Organizations participating in the Enhanced Track of the Medicare Shared Savings Program, multiple commercial value-based models and… more
- CVS Health (Austin, TX)
- …transformation, and administrative support. CVS Accountable Care is seeking an Executive Director , Payor Medical Economics to join our growing organization. In ... business, is a strategic partner in value-based care serving more than 1M Medicare beneficiaries, and over 60K provider partners across 230 clients in ACO REACH,… more
- CenterWell (Austin, TX)
- …The Associate Director , Risk Adjustment oversees quality assurance audits of medical records, ICD-10-CM, CPT, & HCPCS codes that are submitted to the Centers ... for Medicare and Medicaid Services (CMS), other payers, and over...payers, and over government agencies. In addition, the Associate Director , Risk Adjustment oversees all medical coding… more
- CVS Health (Austin, TX)
- …beneficiary health and experience, drive quality, create clinical efficiencies, and control medical costs. In addition, the Executive Director of Population ... The Executive Director of Population Health reports to the Chief Medical Officer and is accountable for achieving business results in areas of responsibility… more
- Humana (Austin, TX)
- …caring community and help us put health first** The Associate Director , Actuarial Analytics/Forecasting analyzes and forecasts financial, economic, and other data ... medium and long-term financial and competitive position. The Associate Director , Actuarial Analytics/Forecasting requires a solid understanding of how organization… more
- Bayer (Austin, TX)
- **Associate Director - Field Reimbursement - Oncology - South Texas** **Associate Director - Field Reimbursement - Oncology - South Texas** **PURPOSE** ... HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals. Develop collaborative working… more
- Humana (Austin, TX)
- …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
- CVS Health (Austin, TX)
- …care more personal, convenient and affordable. **Job Purpose and Summary:** The Dental Director - Medicare Appeals is an individual contributor who will assure ... + Basic knowledge of dental benefit products and platforms (DMO, PPO, Medicare Advantage) + Strong understanding of clinical quality programs, and clinical… more
- Prime Therapeutics (Austin, TX)
- …legislative/oversight bodies (eg, URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQA- National Committee for ... passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description Summary**… more
- Conviva (Austin, TX)
- …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 (Austin, TX)
- …health first** Humana's Marketing organization is seeking a dynamic and experienced Director , Campaign Planning & Orchestration Leader to join our team. This leader ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
- Humana (Austin, TX)
- …of providing frameworks to maximize available resources to achieve growth. The ** Director ,** **Medicaid Insurance Product Management - Growth & Innovation** will be ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
- CVS Health (Austin, TX)
- …health care more personal, convenient and affordable. **Position Summary:** **The Lead Director , Operations (hiring for two positions)** plays a key role by leading ... across executive, providers, and administrative staff. + Relationship building + Medical cost, risk, and quality analysis + Transforming data to influence,… more