- Elevance Health (Independence, OH)
- ** Medicare Medical Director ** Location: This position will work a hybrid model (remote and office). The ideal candidate will must live within 50 miles of one ... Candidates must be able to work Eastern Time Zone hours. The ** Medicare Medical Director ** is responsible for the administration of physical and/or… more
- Molina Healthcare (Cleveland, OH)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Cleveland, OH)
- …Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims * Knowledge of HMO, PPO, POS, MCO, Medicare , Medicaid, ... Market Place products, laws, rules and regulations **Preferred Education** * Master's degree **Preferred Experience** * Formalized training/experience in Health Care Insurance Fraud * Experience with Power BI, SAS, SQL other reporting software * ICD-10 CPT-4,… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Medical Mutual' s status as a ... reside within a 50-mile radius of the Brooklyn, OH Medical Mutual office._** Founded in 1934, Medical ...Performs other duties as assigned. **Lead Sourcing Specialist** **Assists Director of Procurement in the strategic sourcing initiatives to… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Medical Mutual' s status as a ... Translates resulting insights into actionable recommendations to support decision making across Medical Mutual. Partners closely with the Director of Competitive… more
- Brookdale Senior Living (Westlake, OH)
- …pertinent medical data; developing and implementing procedures with the Director , Clinical Services for arrival of newly admitted residents; ensuring that all ... Responsible for overseeing the generation of Minimum Data Set (MDS) for each Medicare patient and electronic transmission of required data within time frame mandated… more
- Molina Healthcare (Cleveland, OH)
- …therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics ... + Provides medication therapy management including examination of member medical records, performing a comprehensive medication review, and communicating with… more
- Gentiva (Independence, OH)
- …in the **Cleveland/Independence** area. You will report directly to the Executive Director , Administrator, or Senior Patient Care Manager. You will be responsible ... referrals/inquiries in a timely, professional, and compassionate manner, including triage of medical concerns within scope of practice. + Preparing for, serving on,… more