- Highmark Health (Des Moines, IA)
- …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 (Des Moines, IA)
- …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
- Prime Therapeutics (Des Moines, IA)
- …our 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 Specialty Clinical Solutions team.… more
- Humana (Des Moines, IA)
- …a part of our caring community and help us put health first** Director of Enterprise Information Protection (EIP) Cybersecurity Engineering focused on building a ... decentralized systems. * Google Cloud Professional Machine Learning Engineer * Agile Remote /WAH requirements: + WAH requirements: Must have the ability to provide a… more
- CVS Health (Des Moines, IA)
- …**Position Summary** CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs. We need a Double Board ... clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director ( Medical Affairs) will report into… more
- Humana (Des Moines, IA)
- **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 (Des Moines, IA)
- …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
- Elevance Health (West Des Moines, IA)
- …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 work a hybrid model ( remote and office). The ideal candidate will live within 50 miles of one… more
- Elevance Health (Des Moines, IA)
- **Program Director , LTSS Value Based and Workforce Initiatives** **Location:** This position will work a hybrid model ( remote and office). The ideal candidate ... 50 miles of one of our Elevance Health PulsePoint locations. The **Program Director , LTSS Value Based and Workforce Initiatives** position is part of the national… more
- Humana (Des Moines, IA)
- …a part of our caring community and help us put health first** Associate Director of Digital Experience Solutions (DES) Architecture In support of our vision to ... and to enable effectiveness and efficiency of technology decisions. The Associate Director of Digital Experience Solutions (DES) Architecture is a highly visible… more
- Humana (Des Moines, IA)
- …Best Places to Work, and be a part of our dynamic team as the Director of Technology Solutions. We are on a mission to revolutionize our Customer Relationship ... this pivotal role is your chance to make a substantial impact! As the Director of Technology Solutions, you will spearhead the strategy and execution of IT… more
- Cardinal Health (Des Moines, IA)
- …team is passionate about helping oncology practices navigate the future. The Director , Managed Care is responsible for strategy and management of managed care ... responsible to implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing… more
- HealthEdge Software Inc (Des Moines, IA)
- …to solve critical needs in healthcare. This individual will report to the Chief Medical Officer of Healthedge (HE) and ensure that our clinical suite of products ... Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other...Work across multiple time zones in a hybrid or remote work environment. + Long periods of time sitting… more
- Aston Carter (Des Moines, IA)
- …compliant billing data and records. Maintains efficient and effective operations of Medicaid , Medicare, Private Insurance, Private Pay, and other payer sources which ... up collecting funds. Coordinates and ensures the entity and all its medical professionals, qualified or specified to provide revenue-generating services, are current… more
- Public Consulting Group (Des Moines, IA)
- …intersection and overlap between our Special Education/Case Management and school-based Medicaid services work within a state; regularly engage with counterparts + ... clients + Understand and continually monitor Federal, state, and local Medicaid School-Based program policies and guidance, collaborating with PCG subject matter… more