- 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
- Elevance Health (Washington, DC)
- ** 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
- 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 (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 (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 (Washington, DC)
- …determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Director will learn National LTSS State ... **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… more
- 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 (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
- 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
- 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
- Genesis Healthcare (Reston, VA)
- …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 The Assistant Director of Rehab is responsible for assisting the ...period of one year. 5. A thorough knowledge of Medicare and third party billing is also required. 6.… more
- Humana (Washington, DC)
- …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
- 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 (Washington, DC)
- …of our caring community and help us put health first** The Director , IT Vendor Management establishes and implements hardware and software acquisition, protection, ... and procedures that are aligned with IT standards and strategy. The Director , IT Vendor Management requires an in-depth understanding of how organization… more
- 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
- 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
- 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
- Sumitomo Pharma (Washington, DC)
- …a dynamic, highly motivated, and experienced individual for the position of ** Director , Pricing and Contracting.** This position reports to the **Executive ... Director , Pricing, Contracting & Policy** . The ** Director...analytics and financial modeling + Understanding of Commercial and Medicare Part D pharmacy benefit designs + Understanding of… more
- 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
- 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