- Humana (St. Paul, MN)
- …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
- Elevance Health (Mendota Heights, MN)
- …deliver member-centered, lasting pharmacy care. In this pivotal role on our CarelonRx Medicare Sales and Account Management team, the Pharmacy Account Director ... preserving and deepening relationships with clients which include Elevance Health Medicare Health Plans. This position, structured around geographic regions and… more
- Humana (St. Paul, MN)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... of the Medicare rules, Humana policies and medical necessity. The Medical Director ...diverse resources, included but not limited to CMS policies, National and Local Coverage Determinations, CMS-recognized Compendia, NCCN, Humana… more
- Humana (St. Paul, MN)
- **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 (St. Paul, MN)
- **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
- Humana (St. Paul, MN)
- **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
- Evolent Health (St. Paul, MN)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you will be a key member of ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Humana (St. Paul, MN)
- …us put health first** Humana Healthy Horizons is seeking an Associate Director , Medicaid Implementation (Business Project Management) to lead within a specific ... and project management are best suited for this role. The Associate Director , Medicaid Implementation (Business Project Management) will provide oversight to the… more
- Humana (St. Paul, MN)
- …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
- CVS Health (Bloomington, MN)
- …on high-value medical rebate contracts and value based agreements for Medicare Part B, Managed Medicaid, and Commercial segments. This includes management of the ... lowering costs and improving quality of care. In this Director level role, you will have the opportunity to...PBM industry + Strong knowledge and understanding of pharmaceutical medical rebates, buy and bill, and/or Medicare … more
- Humana (St. Paul, MN)
- …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 (St. Paul, MN)
- …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
- Bayer (Minneapolis, MN)
- …diverse minds to make a real difference, there's only one choice.** **Associate Director - Field Reimbursement - Oncology Great North** **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 (St. Paul, MN)
- …of our caring community and help us put health first** The Director , Technology Solution Implementation delivers new technological solutions to meet business needs ... within a specified scope while aligned to enterprise objectives. The Director , Technology Solution Implementation requires an in-depth understanding of how… more
- Conviva (St. Paul, MN)
- …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
- Evolent Health (St. Paul, MN)
- …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 (St. Paul, MN)
- …line of business. The Quality Improvement Program Lead reports directly to the National Medicaid Quality Director . The Quality Improvement Program Lead exercises ... for the end to end ownership of Humana Healthy Horizon's National Quality Improvement (QI) efforts, capability advancement activities, and the development… more
- Evolent Health (St. Paul, MN)
- …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
- Intermountain Health (St. Paul, MN)
- …current Medicare and Medicaid regulations. 3. Working knowledge of medical terminology, billing, reimbursement and coding guidelines in both hospital and ... operational owners implementing government payer changes. 5. Collaborates with the Sr. Director and Directors in RSC, educates the applicable leaders and associates… more
- Prime Therapeutics (St. Paul, MN)
- …of utilization management decisions. + On a requested basis, may function as Medical Director for select health plans or regions, assuming overall accountability ... member of the utilization management team, and provides timely medical review of service requests that do not initially... Affairs. + Other duties as assigned. **Responsibilities** + Medicare Part D experience preferred. + Doctor of Medicine… more