- HCA Healthcare (Nashville, TN)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Managed Care Payer Enrollment Director with Parallon, you can be ... you need to succeed in our organization. We are looking for an enthusiastic Managed Care Payer Enrollment Director to help us reach our goals. Unlock your… more
- Vanderbilt University Medical Center (Nashville, TN)
- …and quality and data managers within each transplant program. + Works closely with the Director of Managed Care Contracting and the Transplant Center ... Associate Operating Officer will design, implement, and evaluate clinical, and financial managed care agreements with insurance providers and track and evaluate… more
- e CancerCare (Nashville, TN)
- …with Health Insurance companies (ex. Blue Cross, Blue Shield, IPA, etc). Reporting to the Director of Managed Care , the Manager of Contracting is responsible ... aligns negotiation with strategy. Essential Functions: In collaboration with the Director of Managed Care , negotiate and manage assigned contracts, including… more
- Community Health Systems (Franklin, TN)
- …of claim problems and resolution; standards within compliance of government and managed care contract terms. **Essential Functions** + Performs follow-up on ... impacting area of responsibility. + Displays competency in health care billing requirement/follow up. Maintains current knowledge regarding assigned/related area… more
- Humana (Nashville, TN)
- …services (such as inpatient rehabilitation). **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... management. The clinical scenarios arise from outpatient, inpatient or post-acute care environments. The Medical Director will have discussions with external… more
- Humana (Nashville, TN)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with...size of region or line of business. The Medical Director conducts Utilization Management of the care … more
- Humana (Nashville, TN)
- …adapt and the courage to innovate. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid ... a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with...to a Lead Medical Director . The Medical Director conducts Utilization Management of the care … more
- Humana (Nashville, TN)
- …skills with 5+ years of established clinical experience + Knowledge of the managed care industry including Medicare or Medicaid products + Possess analysis ... the medical necessity of a given service, level of care , or medical item/supply. The Medical Director 's...of care , or medical item/supply. The Medical Director 's work assignments involve moderately complex to complex issues… more
- Trevecca Center for Rehabilitation and Healing (Nashville, TN)
- …Effectively managing key relationships with hospital therapists, physicians, key hospital staff, managed care providers, rehab suppliers, and other key referral ... Assistant Director of Rehabilitation (ADOR) The Assistant Director...internal departmental communication and operations, facilitating and coordinating patient care , quality assurance, census development and marketing of Rehabilitation… more
- Community Health Systems (Franklin, TN)
- …with other departments such as Market Operations, Physician and Clinical Services, Managed Care , Strategy and Business Development, Legal, and Compliance **.** ... to improve quality of patient care and reduce unnecessary post-acute care utilization. The Director will be able to consider financial and quality of care… more
- HCA Healthcare (Nashville, TN)
- …is incentive eligible. **Introduction** Do you have the career opportunities as a(an) Director Data Protection you want with your current employer? We have an ... and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +...of colleagues. Do you want to work as a(an) Director Data Protection where your passion for creating positive… more
- Nashville Center for Rehabilitation and Healing (Nashville, TN)
- …an understanding of MDS requirements related to varied payers including Medicare, Managed Care and Medicaid + Ensures timely electronic submission of ... RN MDS Director Nashville Center for Rehabilitation and Healthcare Center...and thorough completion of the Minimum Data Set (MDS), Care Area Assessments (CAAs) and Care Plans,… more
- Prime Therapeutics (Nashville, TN)
- …is required. + 10 years of relevant work experience, to include 5 years of managed care or related PBM experience. + 7 years of leadership/people management ... drives every decision we make. **Job Posting Title** Senior Director of Underwriting - REMOTE **Job Description** The Sr....data. + Strong Knowledge of underwriting principles in a managed care environment. + Excellent written and… more
- HCA Healthcare (Brentwood, TN)
- …in addition to experience with MSOs/PHOs/IPAs, physician practice management or managed care organizations. + Strong financial background required. + ... care like family! Jump-start your career as a ** Director ** **of Development** today with HCA Healthcare. **Office Address:...vary by location._** Come join our team as a Director of Development. We care for our… more
- Community Health Systems (Franklin, TN)
- …include, but are not limited to: Practice Management from all regions, Managed Care , Acquisitions, PPSI, Provider Enrollment, Medical Staff Development and ... times. + An understanding of health plan/hospital and physician managed care commercial and Medicare reimbursement methodologies...part of the application or hiring process, contact the director of Human Resources at the facility to which… more
- Elevance Health (Nashville, TN)
- …background. Highly preferred skills and experiences: + Healthcare industry experiences in managed care or providers preferred + Demonstrated ability to work ... over 150 years. With capabilities spanning pharmacy, behavioral health, complex care delivery, medical benefits management, payment integrity, palliative care ,… more
- Community Health Systems (Franklin, TN)
- …including the CMS Quality Payment Program, ACO Quality Reporting, HEDIS, and managed care quality reporting. + Establishes mechanisms to support population ... **Job Summary** The Senior Director , Physician Practice Support provides expert leadership and strategic guidance in the development and implementation of quality… more
- CVS Health (Nashville, TN)
- …Key areas of focus include Medicare Part D, Medicare Part B, Medicare Managed Care (MMP demonstrations), Employer Group Waiver Plans (EGWPs), and Retiree ... purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our...103 million plan members. Caremark is recruiting an Executive Director for Medicare Regulatory Affairs to play a crucial… more
- Norstella (Nashville, TN)
- Director , Engineering - Technology (Eastern Time Zone) Company: Panalgo Location: Remote, United States Date Posted: Mar 5, 2025 Employment Type: Full Time Job ID: ... to generate insights into improving population health, quality of care , and managing costs. Now, Panalgo is proud to...**The Role:** We are seeking a talented and creative Director , Engineering with experience in big data for our… more
- Prime Therapeutics (Nashville, TN)
- …or GED is required + 10 years of relevant work experience, to include 5 years of managed care or related PBM experience, 3 years of experience in the areas of ... our passion and drives every decision we make. **Job Posting Title** Sr. Director Rebate Forecasting - Remote **Job Description** The Senior Director Rebate… more