- Humana (Denver, CO)
- …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 ...or Surgery specialties + Utilization management experience in a medical management review organization, such as Medicare … more
- Humana (Denver, CO)
- …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 (Denver, CO)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify … more
- Humana (Denver, CO)
- **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 (Denver, CO)
- **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 (Denver, CO)
- **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 (Denver, CO)
- …caring community and help us put health first** The Associate Director , Actuarial Analytics/Forecasting analyzes and forecasts financial, economic, and other data ... medium and long-term financial and competitive position. The Associate Director , Actuarial Analytics/Forecasting requires a solid understanding of how organization… more
- Bayer (Denver, CO)
- …diverse minds to make a real difference, there's only one choice.** **Associate Director - Field Reimbursement - Oncology - Denver/Utah** **Associate Director - ... HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals. Develop collaborative working… more
- Humana (Denver, CO)
- …our caring community and help us put health first** The Associate Director , Cloud Architecture designs, builds, and maintains data processing architectures and ... and unstructured data to insights at enterprise scale. The Associate Director , Cloud Architecture requires an in-depth understanding of how organization capabilities… more
- Prime Therapeutics (Denver, CO)
- …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
- Conviva (Denver, CO)
- …of our caring community and help us put health first** The Associate Director , Security Architecture will play a key role in implementing security architecture, ... ensure the enterprise can achieve the enterprise security strategy. The Associate Director , Security Architecture will play a key role in implementing security… more
- Humana (Denver, CO)
- …health first** Humana's Marketing organization is seeking a dynamic and experienced Director , Campaign Planning & Orchestration Leader to join our team. This leader ... 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 (Denver, CO)
- …of providing frameworks to maximize available resources to achieve growth. The ** Director ,** **Medicaid Insurance Product Management - Growth & Innovation** will be ... 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
- CVS Health (Denver, CO)
- …health care more personal, convenient and affordable. **Position Summary:** **The Lead Director , Operations (hiring for two positions)** plays a key role by leading ... across executive, providers, and administrative staff. + Relationship building + Medical cost, risk, and quality analysis + Transforming data to influence,… more
- Evolent Health (Denver, CO)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients,… more
- Humana (Denver, CO)
- …organizations in the country. The Healthcare Strategy team supports Humana's Medicare and Medicaid business unit. This business unit, Humana's largest, comprises ... experience leveraging core consulting skills to support delivering some of Medicare and Medicaid's highest priority projects and initiatives, with an emphasis… more
- Evolent Health (Denver, CO)
- …on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization ... as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures...support. + On a requested basis, may function as Medical Director for selecting health plans or… more
- State of Colorado (Denver, CO)
- …Review + Conduct periodic checks to ensure facilities practice aligns with national standards + Conduct routine, independent checks to ensure facilities are in ... The Joint Commission (TJC) standard and The Centers of Medicare & Medicaid Services (CMS) rules and regulations specific...this position requires collaboration with the hospitals and unit director to develop new and improved review methodologies +… more
- State of Colorado (Golden, CO)
- …Ensures that menus and recipes are followed in order to comply with National School Lunch Program, School Breakfast Program and DYS policies and procedures. When ... quarterly, and yearly reports, records, and forms for compliance with the National School Lunch Program, School Breakfast Program, Donated Foods Program, Rules and… more
- University of Colorado (Aurora, CO)
- …+ Serve in leadership role within the clinic or pod as designated by the medical director . + Participate in ongoing and new quality improvement projects within ... in order to obtain full prescriptive authority and DEA registration. + Medicare /Medicaid credentials. + Unrestricted DEA license. + National certification by… more