- Humana (Nashville, TN)
- **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 (Nashville, TN)
- …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 (Nashville, TN)
- …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 reviews cases of diverse scope...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Elevance Health (Nashville, TN)
- …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
- The Cigna Group (Nashville, TN)
- …of the National Development and Network Solutions team, reporting directly to the Medicare National Partnerships Director . This role is a key contributor ... **What You'll Do** The Medicare National Contracting Advisor position is...vet contract impact, including but not limited to: Claims, Medical Management, Credentialing, Legal, Medical Economics, Compliance,… more
- The Cigna Group (Nashville, TN)
- …Senior Manager will work with the Provider Data Quality & Accuracy (PDQA) Director to establish the framework and policies to drive improvements in the provider ... Functions and Responsibilities** + Coordinate and partner with the key Medicare operations teams, including claims, enrollment, fulfillment, network operations, and… more
- Humana (Nashville, TN)
- **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 (Nashville, TN)
- **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 (Nashville, TN)
- **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
- CenterWell (Nashville, TN)
- …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 (Nashville, TN)
- …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
- CenterWell (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Director , Medical Coding extracts clinical information from a variety of medical ... and medical codes (eg, ICD-10-CM, CPT) to patient records. The Director , Medical Coding requires an in-depth understanding of how organization capabilities… more
- Elevance Health (Nashville, TN)
- **Reporting and Analytics Director ** **Location:** This position will work a hybrid model (remote and in office one day per week). Ideal candidates will live within ... KY, Wilmington, DE, Tampa, FL or Nashville, TN. The **Reporting and Analytics Director ** is responsible for high-priority analytical projects for the Medicare … more
- HCA Healthcare (Nashville, TN)
- …you want to join an organization that invests in you as a Senior Director Regulatory and Accreditation? At HCA Healthcare, you come first. HCA Healthcare has ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...a difference. We are looking for a dedicated Senior Director Regulatory and Accreditation like you to be a… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a(an) Director Regulatory and Accreditation? At HCA Healthcare, you come first. HCA Healthcare has ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...make a difference. We are looking for a dedicated Director Regulatory and Accreditation like you to be a… more
- Vanderbilt University Medical Center (Nashville, TN)
- **Discover Vanderbilt University Medical Center:** Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, ... **Organization:** VICC - Clinical Trials 40 **Job Summary:** The Assistant Director supervises a team of pre-award financial analysts; analyzes and Evaluates… more
- Humana (Nashville, TN)
- …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 (Nashville, TN)
- …health first** Humana Healthy Horizons in Virginia is seeking an Associate Director , Care Management (LTSS/ABD) who will lead teams of healthcare professionals ... in providing integrated services for the clinical teams. The Associate Director , Care Management requires a solid understanding of how organization capabilities… more
- Prime Therapeutics (Nashville, TN)
- …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 (Nashville, TN)
- …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