• Medicare Grievances and Appeals Corporate…

    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
    Humana (01/07/25)
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  • Manager, FP&A, Medicare /Medicaid of IL

    CVS Health (Annapolis, MD)
    …and affordable. **Position Summary** As the Manager, FP&A, you will report directly to Director of Finance and will monitor the end to end profit & loss statements, ... data submission for the purpose of rate setting and medical trend analysis on behalf of the Health Plan....nature of this remote role, candidates must have some Medicare and/or Medicaid experience. **Required Qualifications** -5 or more… more
    CVS Health (01/17/25)
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  • Medical Director - Mid West Region

    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 (10/29/24)
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  • Medical Director - Gulf South

    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
    Humana (12/03/24)
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  • Medical Director --Claims Management

    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
    Humana (10/29/24)
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  • Field Medical Director , Cardiology

    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
    Evolent (11/15/24)
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  • Field Medical Director , Radiology…

    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
    Evolent (12/09/24)
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  • Medical Director - Commercial…

    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
    CVS Health (11/13/24)
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  • Managing Director , Value Based Care…

    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
    Evolent (01/22/25)
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  • Director -Rehab OT

    Genesis Healthcare (Mitchellville, MD)
    …Powerback is the place for you. **Why Powerback?** + **Benefits:** We offer Medical , Dental, and Vision plans to Full-Time and Part-Time team members. + **Support ... expertise with our Clinicians in Action professional development program. Responsibilities The Director of Rehab OT is responsible for the efficient management of… more
    Genesis Healthcare (01/21/25)
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  • Associate Director , Actuarial

    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
    Humana (12/12/24)
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  • Regional Account Director

    Takeda Pharmaceuticals (Washington, DC)
    …to the best of my knowledge. **Job Description** **Regional Account Director ** **Takeda Pharmaceutical** **USA-MA-Virtual** **About the role:** Are you looking for ... you to shine? Join us as the Regional Account Director ; reporting into the Head of Corporate Accounts. This...accounts. Responsible for all books of business - Commercial, Medicare , State Medicaid and Managed Medicaid + Gain, protect… more
    Takeda Pharmaceuticals (01/16/25)
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  • Associate Director Cloud Architecture

    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
    Humana (11/02/24)
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  • Policy & Reimbursement, Senior Director

    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
    GRAIL (12/07/24)
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  • Director -Asst Rehab Clinical

    Genesis Healthcare (Waldorf, MD)
    …Powerback is the place for you. **Why Powerback?** + **Benefits:** We offer Medical , Dental, and Vision plans to Full-Time and Part-Time team members. + **Support ... with our Clinicians in Action professional development program. Responsibilities The Assistant Director of Rehab (or In-Training Director of Rehab) is… more
    Genesis Healthcare (01/10/25)
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  • Associate Analytics, Insights & Operations…

    United Therapeutics (Washington, DC)
    …orphan diseases. **How you'll contribute** The Associate Analytics, Insights and Operations Director , Market Access will lead data support across all functions of ... Compliance, Legal, Information Technology, Sales & Marketing Operations, Finance, and Medical Affairs / HEOR. Additionally, this role will support special pricing… more
    United Therapeutics (01/23/25)
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  • Director , Insurance Strategy

    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
    Humana (12/21/24)
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  • Director - Public Affairs - Policy - Tax…

    Novo Nordisk (Washington, DC)
    …potential? This role can sit in Plainsboro, NJ or Washington, DC. The Position The Director - US Tax, Trade, IP works on complex issues that will require an in-depth ... globally. Relationships Reports to the Market Access and Public Affairs Senior Director , Policy. Other internal relationships include a dotted line with Corporate… more
    Novo Nordisk (11/19/24)
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  • Director , Federal Affairs

    Humana (Washington, DC)
    …caring community and help us put health first** Humana is seeking a Director of Government Federal Affairs to join our growing government Federal affairs department, ... Affairs. **Location:** Washington, DC **-** hybrid in office The role of Director , Federal Government Affairs involves direct engagement with Senate, House, and/or… more
    Humana (01/16/25)
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  • Director -Rehab Clinical

    Genesis Healthcare (Bowie, MD)
    …Powerback is the place for you. **Why Powerback?** + **Benefits:** We offer Medical , Dental, and Vision plans to Full-Time and Part-Time team members. + **Support ... Clinicians in Action professional development program. Responsibilities As a Director of Rehabilitation, you are leading a team of...in the state of practice 3. Thorough knowledge of Medicare and third party billing required 4. Must have… more
    Genesis Healthcare (01/10/25)
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