- Humana (Trenton, NJ)
- …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
- Elevance Health (Woodbridge, NJ)
- ** Director of Medicare Risk Adjustment Analytics and Reporting** **Location:** Alternate locations may be considered. This position will work a hybrid model ... will live within 50 miles of our Elevance Health PulsePoint locations. The ** Director of Medicare Risk Adjustment Analytics and Reporting** is responsible for… more
- CVS Health (Trenton, NJ)
- …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
- Humana (Trenton, NJ)
- **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 (Trenton, NJ)
- **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 (Trenton, NJ)
- **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
- RWJBarnabas Health (Oceanport, NJ)
- …cost reports filings. In partnership with the Vice President of Corporate Reimbursement, the Director will manage the completion of DSH, Medicare Bad Debts, Wage ... Director , Corporate Reimbursement (Hybrid/Remote) - Oceanport, NJReq #:0000180233...as a key resource to department leadership for providing Medicare and Medicaid reimbursement support and implementing government payment… more
- Molina Healthcare (New York, NY)
- **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to… more
- Evolent (Trenton, NJ)
- …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. ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Humana (Trenton, NJ)
- **Become a part of our caring community and help us put health first** The Medical Director 's primary responsibility is the review of medical authorizations ... necessity of a given service, level of care, or medical item/supply. The Medical Director 's...experience + Knowledge of the managed care industry including Medicare or Medicaid products + Possess analysis and interpretation… more
- Mount Sinai Health System (New York, NY)
- …environments * Seek to improve the status quo **Role Summary:** MSHP seeks a Medical Director (MD), Physician Engagement and CDQI, who will (1) be responsible ... to drive accurate risk adjustment throughout the system. This Medical Director must be effective at influencing...all populations served, especially our patients covered under a Medicare arrangement (MSSP or MA). The MD will report… more
- Evolent (Trenton, NJ)
- …Evolent 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. ... timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- CVS Health (Trenton, NJ)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... Management staff ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on review appeal cases for… more
- BAYADA Home Health Care (Livingston, NJ)
- **BAYADA** Home Health Care has an immediate opening for a ** Director ** to lead Medicare Certified services in Essex and Hudson Counties. This role requires an ... Health or health care management experience required. Knowledge of Medicare Conditions of Participation strongly preferred. _This position is...NJ and North Bergen, NJ._ **As a Home Health Director your day may look like this!** + Responsible… more
- Evolent (Trenton, NJ)
- …$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
- Phoenix House (Long Island City, NY)
- …required regulatory and Healthcare Departments Policies and Procedures. + Works closely with Medical Director , CEO, Director of Residential Services, ... supply and equipment budgets in collaboration with the staff, medical director and CEO. + Develops measures...NYS RN License + NPI Number + Medicaid / Medicare Number (preferred) **REQUIRED EXPERIENCE** + Excellent verbal, written… more
- New York State Civil Service (Staten Island, NY)
- …HELP No Agency People With Developmental Disabilities, Office for Title Deputy Director DDSO 2 Occupational Category Health Care, Human/Social Services Salary Grade ... innovative leader who can execute strategic decisions to serve as Deputy Director of the Developmental Disabilities State Operations Office in Region 5 (DDSOO… more
- Ascendis Pharma (Princeton, NJ)
- …mission of developing new and potentially best-in-class therapies to address unmet medical needs. Our culture fosters a place where skilled, adaptable, and highly ... develop their skills. Ascendis Pharma is looking to hire an experienced Director , Contract Operations to join our team. Responsibilities will include implementing… more
- Atlantic Health System (Morristown, NJ)
- Atlantic Health System/Goryeb Children's Hospital is Seeking a Program Director for our Pediatric Residency Training Program located in Morristown, New Jersey The ... Health System, is a branch campus of Sidney Kimmel Medical College at Thomas Jefferson University. The role of...College at Thomas Jefferson University. The role of Program Director involves a commitment of 60% administrative responsibilities and… more
- Humana (Trenton, NJ)
- …of our caring community and help us put health first** The Director , BH Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other ... provider contracts and agreements with behavioral health providers. The Director , BH Provider Contracting requires an in-depth understanding of how organization… more