- CareFirst (Baltimore, MD)
- …based on business needs and work activities/deliverables that week.The Director , Utilization Management provides strategic leadership of the utilization management ... Will be responsible for the Commercial, Federal Employee Program, Medicaid, and Medicare lines of business. Establishes performance metrics to ensure the needs and… more
- Humana (Annapolis, MD)
- Humana Director , Actuarial of Medicaid Pricing Annapolis, Maryland Apply NowBecome a part of our caring community and help us put health firstThe Director , ... of actuarial and business needs for specific product lines. The Director , Actuarial requires an in-depth understanding of how organization capabilities interrelate… more
- Humana (Annapolis, MD)
- …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 to complex issues...authorized. All work occurs within a context of regulatory compliance and work is assisted by diverse resources which… more
- Humana (Annapolis, MD)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources, which...and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will… more
- Humana (Annapolis, MD)
- …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 and complexity ranging...and appropriateness of services rendered by healthcare professionals in compliance with CMS guidelines, clinical coverage criteria, and quality… more
- Humana (Annapolis, MD)
- …help us put health first** Humana Healthy Horizons in Virginia is seeking an Associate Director , Care Management (LTSS/ABD) who will lead teams of healthcare ... and guide others in providing integrated services for the clinical teams. The Associate Director , Care Management requires a solid understanding of how… more
- Humana (Annapolis, MD)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Humana (Annapolis, MD)
- …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 ... requires an in-depth evaluation of variable factors. **Job Profile** The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Annapolis, MD)
- …**Additional Information** Typically reports to a Lead, may also report to a Regional/ Associate Vice President or Corporate Medical Director , depending on size ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- CareFirst (Baltimore, MD)
- …based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the utilization management ... Will be responsible for the Commercial, Federal Employee Program, Medicaid, and Medicare lines of business. Establishes performance metrics to ensure the needs and… more
- CareFirst (Baltimore, MD)
- … compliance , population health, and/or member/provider experience. + Analyzes Medicare and Medicaid pharmacy and medical drug utilization data to identify ... changed from Hybrid to Remote due to hard-to-fill role. **PURPOSE:** Director , Pharmacy Government Programs is responsible for implementing the organization's… more
- Humana (Annapolis, MD)
- …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 (Annapolis, MD)
- …us put health first for our members, providers and ourselves. Desired Lead Associate to lead and manage the enterprise framework to facilitate and document ... work closely with established functions inside utilization management (Medical Director , clinician decision making teams, quality audits, prior authorization list… more
- Johns Hopkins University (Lutherville, MD)
- …family, provider, and employee satisfaction. The individual reports to the Associate Administrator and Medical Director for Reproductive Endocrinology and ... preauthorization requirements, patient relations and patient satisfaction, clinical regulatory compliance , and program marketing. **Specific Duties & Responsibilities:** +… more
- CenterWell (Annapolis, MD)
- …of third-party payers. Ensures final audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team ... of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. +… more
- CareFirst (Baltimore, MD)
- …our members while pursuing and supporting corporate objectives and maintaining compliance with regulatory bodies. Provides direction and oversight to all doctoral ... a managed care setting. + Previous experience as medical director for a health care company. + At least...teams. **Preferred Qualifications:** + In-depth knowledge of Medicaid and Medicare related programs in a health plan/payor environment, with… more
- Johns Hopkins University (Baltimore, MD)
- …proper research patient care billing process. This position reports to the Associate Director - ORA Clinical Research. **Specific Duties & Responsibilities** ... independent judgement in the resolution of issues regarding clinical research billing compliance . + Must have excellent written and oral communication skills. +… more