- Humana (Lincoln, NE)
- **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 (Lincoln, NE)
- …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 (Lincoln, NE)
- **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 (Lincoln, NE)
- **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 (Lincoln, NE)
- …**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 (Lincoln, NE)
- **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 (Lincoln, NE)
- …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 (Lincoln, NE)
- …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
- CVS Health (Lincoln, NE)
- …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
- Humana (Lincoln, NE)
- …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...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Lincoln, NE)
- …community and help us put health first** The Health Quality & Stars, Medical Cost Management, and Clinical Analytics organization is looking for a seasoned leader ... results and does so efficiently and effectively. **Location:** remote The Director , Strategy Advancement provides data-based strategic direction to identify and… more
- Humana (Lincoln, NE)
- …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
- Prime Therapeutics (Lincoln, NE)
- …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
- Cardinal Health (Lincoln, NE)
- …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
- Humana (Lincoln, NE)
- …providing frameworks to maximize available resources to achieve growth. The ** Director ,** **Medicaid Insurance Product Management and Wellness Strategy** will have ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
- Humana (Lincoln, NE)
- …a part of our caring community and help us put health first** Director of Enterprise Information Protection (EIP) Cybersecurity Engineering focused on building a ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
- Humana (Lincoln, NE)
- …a part of our caring community and help us put health first** Associate Director , Enterprise API Standards and Governance is a pivotal role in leading the technology ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
- HealthEdge Software Inc (Lincoln, NE)
- …NCQA ( National Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other ... 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… more
- Humana (Lincoln, NE)
- …reports required by direct manager and executive team. + Attend state, regional, and national meetings and events as needed or upon request. **Use your skills to ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
- Prime Therapeutics (Lincoln, NE)
- …to questions and resolving complex problems and issues. + If supporting Medicare Part D, will be responsible for implementing CMS requirements related direct ... to plan reconciliation, monthly membership reports, coverage gap discount program, medical loss ratio reporting, fiscal soundness reporting, audit assistance and… more