- Highmark Health (Jefferson City, MO)
- …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 (Jefferson City, MO)
- …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 ... understanding of how organization capabilities interrelate across the function or segment. The Director , Actuarial of Medicaid Pricing may be responsible for any… more
- Prime Therapeutics (Jefferson City, MO)
- …our passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions -RPH/PharmD required- REMOTE **Job Description ... Summary** Responsible for support and development of Medical Pharmacy program strategy as part of the Medical Pharmacy Specialty Clinical Solutions team.… more
- Humana (Jefferson City, MO)
- …a part of our caring community and help us put health first** Director of Enterprise Information Protection (EIP) Cybersecurity Engineering focused on building a ... decentralized systems. * Google Cloud Professional Machine Learning Engineer * Agile Remote /WAH requirements: + WAH requirements: Must have the ability to provide a… more
- Humana (Jefferson City, MO)
- **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 (Jefferson City, MO)
- …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
- Humana (Jefferson City, MO)
- …of our caring community and help us put health first** The Associate Director , Care Management leads teams of nurses and behavior health professionals responsible ... for care management. The Associate Director , Care Management requires a solid understanding of how...Bachelor's Degree. + 5+ years of professional experience in Medicaid and/or Medicare managed care operations, case management, or… more
- HealthEdge Software Inc (Jefferson City, MO)
- …to solve critical needs in healthcare. This individual will report to the Chief Medical Officer of Healthedge (HE) and ensure that our clinical suite of products ... Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other...Work across multiple time zones in a hybrid or remote work environment. + Long periods of time sitting… more
- Humana (Jefferson City, MO)
- …a part of our caring community and help us put health first** Associate Director of Digital Experience Solutions (DES) Architecture In support of our vision to ... and to enable effectiveness and efficiency of technology decisions. The Associate Director of Digital Experience Solutions (DES) Architecture is a highly visible… more
- Humana (Jefferson City, MO)
- …Best Places to Work, and be a part of our dynamic team as the Director of Technology Solutions. We are on a mission to revolutionize our Customer Relationship ... this pivotal role is your chance to make a substantial impact! As the Director of Technology Solutions, you will spearhead the strategy and execution of IT… more
- Cardinal Health (Jefferson City, MO)
- …team is passionate about helping oncology practices navigate the future. The Director , Managed Care is responsible for strategy and management of managed care ... responsible to implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing… more
- SSM Health (Jefferson City, MO)
- …best practices with staff and between teams. Please note that this is NOT a remote opportunity. This role will require relocation to the Jefferson City, MO area upon ... with respect to hospital licensing requirements, Centers for Medicare & Medicaid Services (CMS) Conditions of Participation and accreditation by The Joint… more