- HCA Healthcare (Nashville, TN)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Managed Care Payer Enrollment Director with Parallon, you can be ... you need to succeed in our organization. We are looking for an enthusiastic Managed Care Payer Enrollment Director to help us reach our goals. Unlock your… more
- Vanderbilt University Medical Center (Nashville, TN)
- …and quality and data managers within each transplant program. + Works closely with the Director of Managed Care Contracting and the Transplant Center ... Associate Operating Officer will design, implement, and evaluate clinical, and financial managed care agreements with insurance providers and track and evaluate… more
- e CancerCare (Nashville, TN)
- …with Health Insurance companies (ex. Blue Cross, Blue Shield, IPA, etc). Reporting to the Director of Managed Care , the Manager of Contracting is responsible ... aligns negotiation with strategy. Essential Functions: In collaboration with the Director of Managed Care , negotiate and manage assigned contracts, including… more
- Humana (Nashville, TN)
- …services (such as inpatient rehabilitation). **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... management. The clinical scenarios arise from outpatient, inpatient or post-acute care environments. The Medical Director will have discussions with external… more
- Humana (Nashville, TN)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with...size of region or line of business. The Medical Director conducts Utilization Management of the care … more
- Humana (Nashville, TN)
- …adapt and the courage to innovate. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid ... a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with...to a Lead Medical Director . The Medical Director conducts Utilization Management of the care … more
- Humana (Nashville, TN)
- …skills with 5+ years of established clinical experience + Knowledge of the managed care industry including Medicare or Medicaid products + Possess analysis ... the medical necessity of a given service, level of care , or medical item/supply. The Medical Director 's...of care , or medical item/supply. The Medical Director 's work assignments involve moderately complex to complex issues… more
- Trevecca Center for Rehabilitation and Healing (Nashville, TN)
- …Effectively managing key relationships with hospital therapists, physicians, key hospital staff, managed care providers, rehab suppliers, and other key referral ... Assistant Director of Rehabilitation (ADOR) The Assistant Director...internal departmental communication and operations, facilitating and coordinating patient care , quality assurance, census development and marketing of Rehabilitation… more
- HCA Healthcare (Nashville, TN)
- …is incentive eligible. **Introduction** Do you have the career opportunities as a(an) Director Data Protection you want with your current employer? We have an ... and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +...of colleagues. Do you want to work as a(an) Director Data Protection where your passion for creating positive… more
- Nashville Center for Rehabilitation and Healing (Nashville, TN)
- …an understanding of MDS requirements related to varied payers including Medicare, Managed Care and Medicaid + Ensures timely electronic submission of ... RN MDS Director Nashville Center for Rehabilitation and Healthcare Center...and thorough completion of the Minimum Data Set (MDS), Care Area Assessments (CAAs) and Care Plans,… more
- Prime Therapeutics (Nashville, TN)
- …is required. + 10 years of relevant work experience, to include 5 years of managed care or related PBM experience. + 7 years of leadership/people management ... drives every decision we make. **Job Posting Title** Senior Director of Underwriting - REMOTE **Job Description** The Sr....data. + Strong Knowledge of underwriting principles in a managed care environment. + Excellent written and… more
- Elevance Health (Nashville, TN)
- …background. Highly preferred skills and experiences: + Healthcare industry experiences in managed care or providers preferred + Demonstrated ability to work ... over 150 years. With capabilities spanning pharmacy, behavioral health, complex care delivery, medical benefits management, payment integrity, palliative care ,… more
- CVS Health (Nashville, TN)
- …Key areas of focus include Medicare Part D, Medicare Part B, Medicare Managed Care (MMP demonstrations), Employer Group Waiver Plans (EGWPs), and Retiree ... purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our...103 million plan members. Caremark is recruiting an Executive Director for Medicare Regulatory Affairs to play a crucial… more
- Norstella (Nashville, TN)
- Director , Engineering - Technology (Eastern Time Zone) Company: Panalgo Location: Remote, United States Date Posted: Mar 5, 2025 Employment Type: Full Time Job ID: ... to generate insights into improving population health, quality of care , and managing costs. Now, Panalgo is proud to...**The Role:** We are seeking a talented and creative Director , Engineering with experience in big data for our… more
- Prime Therapeutics (Nashville, TN)
- …or GED is required + 10 years of relevant work experience, to include 5 years of managed care or related PBM experience, 3 years of experience in the areas of ... our passion and drives every decision we make. **Job Posting Title** Sr. Director Rebate Forecasting - Remote **Job Description** The Senior Director Rebate… more
- Elevance Health (Nashville, TN)
- …is preferred + Strategy RFP/Capture Strategy experience is strongly preferred. + Managed Care experience preferred + Demonstrated experience in Provider Strategy ... **Medicaid RFP Development Director ** **Location:** This position will work a hybrid...BA/BS degree in business, public health, nursing, medicine, health care delivery, or a related field and a minimum… more
- Highmark Health (Nashville, TN)
- …year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry **LICENSES AND CERTIFICATION** **Required** + Medical Doctor or ... + Telephone Skills + General Computer Skills + Clinical Software + Managed Care **Language (Other than English)** None **Travel Required** 0% - 25% **PHYSICAL,… more
- AbbVie (Nashville, TN)
- …and broad market knowledge across the sector, geography and franchise(s), including Key Managed Care and Payer dynamics. Share and provide quantitative and ... + Commercial pharmaceutical industry experiences such as physician/account based selling, training, managed health care and marketing. + Ability to set a… more
- Highmark Health (Nashville, TN)
- …Consulting or related area + 3 years Value-based reimbursement, through managed care contracting, provider reimbursement, consulting, population health delivery ... and maintains strategic provider relationships to understand the current health care delivery state, readiness for change, test value based programming concepts… more
- HCA Healthcare (Nashville, TN)
- …and Qualifications** Seeking a Contract Analyst, who is responsible for translating managed care terms and model relevant parameters in Concuity/Clear Contracts ... **What you will do in this role:** + Model managed care contracts through the Concuity Calc...Performance of ad hoc analyses as assigned by departmental Director , Manager and Team Leads + Performs Peer to… more