- Molina Healthcare (Louisville, KY)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Louisville, KY)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... State Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- CommuniCare Health Services Corporate (Corydon, IN)
- Medical Director - Physician Since 1984, CommuniCare Health Services has provided superior, comprehensive management services for the development and management ... Indiana, West Virginia, Virginia, Missouri, Pennsylvania and Maryland. As Medical Director , you will be part of...+ Health care management/leadership experience + Familiarity with CMS, Medicare Advantage, SNP Rules and Regulations + HCC and… more
- Humana (Louisville, KY)
- …and improve controls, operations, and risk management. The Internal Audit Director , Insurance Segment reports directly to Humana's Chief Audit Executive. The ... Internal Audit Director , Insurance Segment will develop and lead risk based...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- ChenMed (Louisville, KY)
- …preferred. + Strongly prefer two (2) years' previous experience as Medical Director or equivalent with a Medicare or Medicaid patient population + Board ... preferred. + Preferred to be an existing high performing PCP partner and/or Medical Director within the ChenMed core model, with a proven ability to manage a… more
- Signature Healthcare (Louisville, KY)
- …Plan of Care for each resident in coordination with the physician, Medical Director , nursing staff, and outside consultants (ie, nursing, dietary, ... 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded...Modern Healthcare's "Best Places to Work!" Overview The ideal Director of Nursing Candidate is very detailed orientated, organized,… more
- Elevance Health (Louisville, KY)
- …care. CarelonRx's Pharmaceutical Rebates Org is looking to hire a ** Director , Formulary Strategy Development.** This high-performing individual contributor will play ... in driving affordability across multiple lines of business (Commercial, Medicaid, Medicare , ASO clients) by partnering with internal and external stakeholders to… more
- Signature Healthcare (Louisville, KY)
- …facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded as a certified Great ... and Modern Healthcare's "Best Places to Work!" Overview The ideal Assistant Director of Nursing Candidate is very detailed orientated, organized, great knowledge of… more
- Signature Healthcare (Louisville, KY)
- …facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded as a certified Great ... Modern Healthcare's "Best Places to Work!" Overview The ideal Director of Nursing Float Candidate is very detailed orientated,...and Signature Perks include the following and more! + Medical , Dental and Vision - Voluntary Life/Disability + 401(K)… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview Director of Clinical Denials Management and Audit supervises a team of RN/LPN clinical reviewers as well as Support ... appeal utilizing relevant and effective clinical documentation from the medical record; supported by current industry clinical guidelines, evidence-based medicine,… more
- Waystar (Louisville, KY)
- **ABOUT THIS POSITION** A Waystar Regional Director must effectively communicate with target account senior leaders and executives, and coordinate strategy with ... systems, and is connected to over 5K commercial and Medicaid/ Medicare payers. We are deeply committed to living out...+ bonus, if applicable) + Customizable benefits package (3 medical plans with Health Saving Account company match) +… more
- Signature Healthcare (Louisville, KY)
- …facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded as a certified Great ... "Best Places to Work!" Overview As the Social Services Director you will identify and provide for each resident's...and Signature Perks include the following and more! + Medical , Dental and Vision - Voluntary Life/Disability + 401(K)… more
- Molina Healthcare (Louisville, KY)
- …Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims * Knowledge of HMO, PPO, POS, MCO, Medicare , Medicaid, ... Market Place products, laws, rules and regulations **Preferred Education** * Master's degree **Preferred Experience** * Formalized training/experience in Health Care Insurance Fraud * Experience with Power BI, SAS, SQL other reporting software * ICD-10 CPT-4,… more
- CenterWell (New Albany, IN)
- …participant and lead with the care team through daily huddles. . Helps Regional Medical Director (RMD), Physician and Center Administrator in setting a tone of ... Appropriate certification to write prescriptions under the authority of a collaborating physician/ medical director . + This role is considered patient facing and… more
- CenterWell (New Albany, IN)
- … medical expertise with the care team through daily huddles. . Helps Regional Medical Director and Center Administrator in setting a tone of cooperation in ... Doctors, Advanced Practice professionals, Pharm D, Care Coach Nurses, Medical Assistants, Behavioral Health, Specialists, Quality Based Coders, Referral Coordinators… more
- ChenMed (Louisville, KY)
- …specific geographic regions. This individual will report to and work with the Network Director to develop the CPL and serve as the local relationship builder with ... for the Center, Specialty, MED COE and HCT leaders to support improved medical costs and specialty care utilization. This individual will work closely with and… more
- Gentiva (New Albany, IN)
- …Provides diagnosis, treatment, consultation, and follow-up under the direction of the Palliative Medical Director (if required under State law). **As a Nurse ... Practitioner, you will:** + Work in collaboration with the Palliative Care Medical Director and other palliative team members to deliver palliative care by… more
- CenterWell (Louisville, KY)
- …audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers ... 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 (Salem, IN)
- …+ Assisting members in maintaining Medicaid eligibility + Collaborate with Medical Director /Geriatrician/Care Coordinator as deemed necessary to ensure cohesive, ... use a variety of electronic information applications/software programs including electronic medical records. + Must perform job responsibility in Indiana + Ability… more
- Waystar (Louisville, KY)
- …to highly useable software. This professional self-starter will report to a Director , Product Management and work closely with User Experience team and Technology ... needs and ensure customer satisfaction and product quality + Assisting your Director of Product Management in coordinating with sales, marketing, development, and… more