- 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 ... encumbrances * Board Certified in ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals… more
- Humana (Springfield, IL)
- …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 (Chicago, IL)
- … medical policy and Medicare Coverage Determinations. The **Associate Medical Director , Clinical Operations** is responsible for supporting the medical ... Benefits Management Medical Necessity Guidelines, client-specific health plan medical policy, state mandates/policies and Medicare determinations + Conduct… more
- Elevance Health (Chicago, IL)
- ** 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 (Springfield, IL)
- …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 (Springfield, IL)
- **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 (Springfield, IL)
- **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 (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
- 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
- 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. ... 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 (Springfield, IL)
- **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
- Evolent (Springfield, IL)
- …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 (Springfield, IL)
- …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
- Evolent (Springfield, IL)
- …$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
- Elara Caring (Des Plaines, IL)
- …this mission. This means you have countless ways to make a difference as Branch Director . Being a part of something this great starts by carrying out our mission ... pioneer in delivering unparalleled care, we need a Branch Director with commitment and compassion. Are you one of...+ Opportunities for advancement + Comprehensive insurance plans for medical , dental, and vision benefits + 401(K) with employer… more
- Edwards Lifesciences (Chicago, IL)
- …healthier lives. Join us and be part of our inspiring journey. The Director , Global Health Economics and Reimbursement is a field-based role responsible for working ... payment, as well as, an intermediary to payers including Center for Medicare Services (CMS) and/or Medicare Administrative Contractors (MAC), Medicaid, Veteran… more
- Humana (Springfield, IL)
- …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 (Springfield, IL)
- …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
- AdventHealth (Hinsdale, IL)
- …that **together** we are even better. **GENERAL SUMMARY:** Consumer Access Regional Director serves as the market leader integrating practices in coordination with ... leadership, and revenue management executives. Reporting to the Consumer Access Executive Director , directs operational oversight as the subject matter expert in the… more
- Ankura (Chicago, IL)
- …operational, clinical, legal, and regulatory matters. Our clients include academic medical centers, health systems, physician practice groups, post- and sub-acute ... pharmacies and pharmacy benefit management companies, as well as pharmaceutical, medical device, and diagnostics manufacturers. Role Overview The expectation of this… more