- Humana (Washington, DC)
- **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 ... the medical necessity of a given service or level of care. The Medical Director 's work assignments involve moderately complex to complex issues where the… more
- Humana (Washington, DC)
- …our caring community and help us put health first** The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The ... Behavioral Health Medical Director work assignments involve moderately complex...internal teaching conferences, and other reference sources * Learns Medicaid requirements and understands how to operationalize this knowledge… more
- Highmark Health (Washington, DC)
- …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 (Washington, DC)
- …and help us put health first** Humana Healthy Horizons is seeking an Associate Director , Medicaid Provider Services to serve in a strategic leadership role ... Medicaid Provider Services team, led by the Associate Director , is accountable for Humana's Medicaid segment...pay and a comprehensive benefits package that includes 401k, Medical , Dental, Vision and a variety of supplemental insurances,… more
- Humana (Washington, DC)
- …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
- 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...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … 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 ... 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 (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 ... to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … 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)
- …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
- Evolent Health (Washington, DC)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you will be a key member of ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...state or federal health care program, including Medicare or Medicaid , and is not identified as an "excluded person"… more
- VHC Health (Arlington, VA)
- OB Medical Director Job Description Purpose & Scope: The physician is a member of the healthcare team who works in collaboration with other staff to provide ... is required. VHC Health Hospital is seeking a visionary Medical Director to lead our Labor and...region that was named a Center for Medicare & Medicaid Services Four-Star Hospital, and is also designated as… more
- VHC Health (Arlington, VA)
- Medical Director - Palliative Care Job...region that was named a Center for Medicare & Medicaid Services Four-Star Hospital, and is also designated as ... objectives, budget, and performance metrics at the individual level.Supports all medical activities at the individual level including implementation of quality… more
- HCA Healthcare (Dulles, VA)
- …Do you want to join an organization that invests in you as an HIM Director ? At StoneSprings Hospital Center, you come first. HCA Healthcare has committed up to $300 ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...a difference. We are looking for a dedicated HIM Director like you to be a part of our… more
- Elevance Health (Washington, DC)
- …and Medicaid Services to transform federal health programs. The ** Director I Medicare Operations** is responsible for directing multiple business function ... ** Director I Medicare Operations** **Location:** This position will...(NGS) a contractor for the Centers for Medicare and Medicaid Services. + Medicare Integrity Operations includes but is… more
- Gilead Sciences, Inc. (Washington, DC)
- …35 countries worldwide, with headquarters in Foster City, California. **Senior Director , Federal Government Affairs** **Job Overview:** Reporting to the Vice ... President of Federal Government Affairs, the Senior Director , Federal Government Affairs will play an integral role in developing and implementing coordinated… more
- Humana (Washington, DC)
- …our caring community and help us put health first** The Associate Director , Data Science uses mathematics, statistics, modeling, business analysis, and technology to ... high volumes of complex data into advanced analytic solutions. The Associate Director , Data Science requires a solid understanding of how organization capabilities… more
- Humana (Washington, DC)
- …our caring community and help us put health first** The Associate Director , Data Science uses mathematics, statistics, modeling, business analysis, and technology to ... high volumes of complex data into advanced analytic solutions. The Associate Director , Data Science requires a solid understanding of how organization capabilities… more
- Humana (Washington, DC)
- …of our caring community and help us put health first** The Associate Director , Agile Coaching guides, educates, and mentors organizational leaders and their teams to ... including Scrum, Kanban and Scaled Agile Framework (SAFe). The Associate Director , Agile Coaching requires a solid understanding of how organization capabilities… more
- Prime Therapeutics (Washington, DC)
- …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 Business Development team. Responsible for managing… more