- 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 ... materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of… more
- Humana (Washington, DC)
- …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. ... The Behavioral Health Medical Director work assignments involve moderately complex...conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare… 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 reviews cases of diverse scope...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Somatus (Mclean, VA)
- …and mental well-being + Community engagement opportunities + And more! The Sr. Director , Medicare Risk Adjustment (MRA) will lead the execution strategy and ... the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Flexible Paid Time Off (PTO) + Professional… 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 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
- CVS Health (Washington, DC)
- …**Position Summary** CVS Health, a Fortune 4 company, has an outstanding opportunity for a Medical Director - Medical Affairs. We need a Board Certified ... clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director ( Medical Affairs) will report into… 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
- CVS Health (Annapolis, MD)
- …and behavioral health programs and services to its membership. Aetna is looking for a medical director to be part of a centralized team that supports the ... related to precertification, concurrent review, and appeal request. The medical director is a work-at-home position located...Two (2) + years of experience in managed care ( Medicare and/or Medicaid) Experience with managed care ( Medicare… more
- CenterWell (Washington, DC)
- …under the PCO's Chief Medical Officer. This role reports to the National Director , High Risk Patient Management. Responsibilities will include: + Lead ... caring community and help us put health first** The National Director , Clinical Pharmacy is a strategic...and promote age-friendly care + Maintain current knowledge of pharmacy/ medical trends within ambulatory/primary care and Medicare … more
- Elevance Health (Washington, DC)
- …reviews within our Medicaid and Medicare programs.** The **Behavioral Health Medical Director ** is responsible for the administration of behavioral health ... of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative...opportunities. May serve as a resource to staff including Medical Director Associates. How you will make… more
- CVS Health (Washington, DC)
- …clinical coverage and policies. **Primary Job Duties & Responsibilities:** Behavioral Health Medical Director + Collaborates with health plan Sr Leadership to ... and services for aligned plan's members. Position Description: Aetna Medicare Duals Center of Excellence is searching for a...the delivery of holistic and integrated person-centered care. The Medical Director will be responsible for provider… more
- CareFirst (Baltimore, MD)
- … pre-authorization review, Medicaid / Medicare intake, and Medicaid / Medicare medical pre-authorization review. More detail can be shared during the ... based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the utilization management… more
- VHC Health (Arlington, VA)
- Medical Director - Palliative Care Job Description Purpose & Scope: The physician is a member of the healthcare team who works in collaboration with other staff ... objectives, budget, and performance metrics at the individual level.Supports all medical activities at the individual level including implementation of quality… more
- CareFirst (Baltimore, MD)
- …quality initiatives, compliance, population health, and/or member/provider experience. + Analyzes Medicare and Medicaid pharmacy and medical drug utilization ... **Resp & Qualifications** **PURPOSE:** Director , Pharmacy Government Programs is responsible for implementing...organization's pharmacy vision and strategic plan for government programs ( Medicare and Medicaid). This role has oversight of pharmacy… 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)
- …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 of ... actuarial and business needs for specific product lines. The Director , Actuarial requires an in-depth understanding of how organization capabilities interrelate… more
- Humana (Washington, DC)
- …part of our caring community and help us put health first** The Director , Federal Affairs represents the organization's position on legislative affairs to elected ... as to officials and staff in regulatory and other agencies. The Director , Federal Affairs requires an in-depth understanding of how organization capabilities… more
- Humana (Washington, DC)
- …health first** Humana Healthy Horizons in Virginia is seeking an Associate Director , Care Management (LTSS/ABD) who will lead teams of healthcare professionals ... in providing integrated services for the clinical teams. The Associate Director , Care Management requires a solid understanding of how organization capabilities… more
- Prime Therapeutics (Washington, DC)
- …legislative/oversight bodies (eg, URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQA- National Committee for ... passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions -RPH/PharmD required- REMOTE **Job Description Summary**… more