- Humana (Annapolis, MD)
- …community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. The Behavioral ... Health Medical Director work assignments involve moderately complex to complex issues...authorized. All work occurs within a context of regulatory compliance and work is assisted by diverse resources which… more
- Humana (Annapolis, MD)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources, which...and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will… more
- Humana (Annapolis, MD)
- …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 reviews cases of diverse scope and complexity ranging...and appropriateness of services rendered by healthcare professionals in compliance with CMS guidelines, clinical coverage criteria, and quality… more
- Humana (Annapolis, MD)
- …help us put health first** Humana Healthy Horizons in Virginia is seeking an Associate Director , Care Management (LTSS/ABD) who will lead teams of healthcare ... and guide others in providing integrated services for the clinical teams. The Associate Director , Care Management requires a solid understanding of how… more
- Humana (Annapolis, MD)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Humana (Annapolis, MD)
- …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 ... requires an in-depth evaluation of variable factors. **Job Profile** The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Annapolis, MD)
- …**Additional Information** Typically reports to a Lead, may also report to a Regional/ Associate Vice President or Corporate Medical Director , depending on size ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- CareFirst (Baltimore, MD)
- …based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the utilization management ... Will be responsible for the Commercial, Federal Employee Program, Medicaid, and Medicare lines of business. Establishes performance metrics to ensure the needs and… more
- CareFirst (Baltimore, MD)
- … compliance , population health, and/or member/provider experience. + Analyzes Medicare and Medicaid pharmacy and medical drug utilization data to identify ... changed from Hybrid to Remote due to hard-to-fill role. **PURPOSE:** Director , Pharmacy Government Programs is responsible for implementing the organization's… more
- Humana (Annapolis, MD)
- …a part of our caring community and help us put health first** The Director , Actuarial of Medicaid Pricing provides actuarial support across a broad range of ... actuarial and business needs for specific product lines. The Director , Actuarial requires an in-depth understanding of how organization capabilities interrelate… more
- Humana (Annapolis, MD)
- …a part of our caring community and help us put health first** The Director , Provider Activation is responsible for the end-to-end process of adding providers to ... increase productivity, and oversees execution of relevant initiatives. The Director , Provider Activation motivates, manages, and leads high-performance teams… more
- Johns Hopkins University (Lutherville, MD)
- …family, provider, and employee satisfaction. The individual reports to the Associate Administrator and Medical Director for Reproductive Endocrinology and ... preauthorization requirements, patient relations and patient satisfaction, clinical regulatory compliance , and program marketing. **Specific Duties & Responsibilities:** +… more
- CenterWell (Annapolis, MD)
- …of third-party payers. Ensures final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team ... of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. +… more
- Humana (Annapolis, MD)
- …seeking a Federal Income Tax Lead responsible for leading the Federal income tax compliance and audit functions to minimize the company's tax burden and maintain its ... payments. + Lead Federal tax examination and appeals processes under IRS Compliance Assurance Process ('CAP' or 'CAP Maintenance'). + Manage Humana's corporate… more
- Johns Hopkins University (Baltimore, MD)
- …proper research patient care billing process. This position reports to the Associate Director - ORA Clinical Research. **Specific Duties & Responsibilities** ... independent judgement in the resolution of issues regarding clinical research billing compliance . + Must have excellent written and oral communication skills. +… more
- Humana (Annapolis, MD)
- …coding, and provide feedback to physicians regarding documentation practices and compliance with state and federal regulations. + Cultivate effective partnerships in ... a matrix environment of coding educators, medical director , clinical and market operations. + Facilitate, track and trend for reporting to leadership and… more