- Humana (Springfield, IL)
- …or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical ... caring community and help us put health first** The Medical Director relies on medical ...Prefer Medicaid experience + Utilization management experience in a medical management review organization, such as Medicare … more
- CVS Health (Springfield, IL)
- … Medicaid Services) requires regulatory changes during the plan year. The ** Medicare ** **Benefits Standards & Guidance Lead Director ** ensures accountability for ... Individual general enrollment, Special Needs Plans (SNP) and Employer Groups. The ** Medicare ** **Benefits Standards & Guidance Lead Director ** acts as the… more
- CVS Health (Springfield, IL)
- …(work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Regulated Medicare Appeals: * Direct daily work on ... 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...* Board Certified in ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance &… more
- Humana (Springfield, IL)
- **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 (Springfield, IL)
- …determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Director will learn National LTSS State ... community and help us put health first** The Long-term services and supports (LTSS) Medical Director 's primary responsibility is the review of medical … more
- Humana (Springfield, IL)
- **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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- CVS Health (Springfield, IL)
- …**Position Summary** CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director ( Medical Affairs). This is a remote based, work ... clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director ( Medical Affairs) will report into… more
- CVS Health (Chicago, IL)
- …with heart, each and every day. **Company:** Oak Street Health **Title:** Center Medical Director - Spanish Required **Location:** Oak Street Health: Hermosa ... Requirement:** Spanish **Role Description:** The purpose of the Center Medical Director role at Oak Street Health...be'', providing personalized primary care for older adults on Medicare , with the goal of keeping patients healthy and… more
- CVS Health (Springfield, IL)
- …with heart, each and every day. Company: Oak Street Health Title: Senior Medical Director , Transitional Care (SMD, Transitional Care) Location: Must be located ... costs and provides an unmatched experience for adults on Medicare in medically underserved communities. By providing holistic, comprehensive...to drive superior clinical and financial results. This Senior Medical Director role will put you at… more
- Evolent (Springfield, IL)
- …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 (Springfield, IL)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Humana (Springfield, IL)
- …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...compliance and assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations,… more
- CVS Health (Springfield, IL)
- …process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject ... CVS Health company has an outstanding opportunity for a Medical Director . Ready to take your career...any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression,… more
- Evolent (Springfield, IL)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Genetic Testing you will be a key member of the utilization ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Rush University Medical Center (Chicago, IL)
- **Job Description** **Location:** Chicago, Illinois **Business Unit:** Rush Medical Center **Hospital:** Rush University Medical Center **Department:** Community ... may vary depending on the circumstances of each case. **Summary:** The Director of Community Based Practices is responsible for leading interprofessional programs… more
- CVS Health (Buffalo Grove, IL)
- …workflows to enhance accuracy and productivity. * Collaborate closely with the SIU Medical Director to align coding practices with organizational goals. * Work ... care more personal, convenient and affordable. **Position Summary:** As the Coding Director , you will oversee the coding operations, ensuring accurate and efficient… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** **Associate Medical Director - Cardiovascular Medicine (Cardiologist) | Evolent Health** Are you ... to drive meaningful change beyond the bedside? Evolent Health is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in… more
- Humana (Springfield, IL)
- …our caring community and help us put health first** The Associate Director - Value-based Specialty and Vendor Support role builds templates, standard documentation, ... case studies, and disseminates best in class knowledge. The Associate Director requires a solid understanding of how organization capabilities interrelate across… more
- AdventHealth (La Grange, IL)
- …Road, La Grange, IL **The role you'll contribute:** The Care Management Facility Director has full accountability and oversight for the overall operations of the ... including but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services (CMS) Conditions of Participation, Discharge Planning, Social… more
- NASCO (Springfield, IL)
- **Overview** As Executive Director , Compliance you will lead and provide oversight and management of Compliance and Privacy functions and serve as the company's ... Compliance Office. This role will have oversight responsibility for Medicare Advantage and ACA Exchanges strategy and executive relationship responsibility… more