• Executive Director , Medicare

    CVS Health (Nashville, TN)
    …group clients and their 103 million plan members. Caremark is recruiting an Executive Director for Medicare Regulatory Affairs to play a crucial role in shaping ... the Medicare regulatory landscape within the Government Services Division and...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… more
    CVS Health (02/08/25)
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  • Medicare Grievances and Appeals Corporate…

    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. The ... Corporate Medical Director works on problems of diverse scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… more
    Humana (01/07/25)
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  • Medicare Systems IT Project Management…

    The Cigna Group (Nashville, TN)
    … technology assets over the acquiring company within the transition period. The Medicare Systems IT Project Management Senior Director is responsible for leading ... As the Program Lead within the Cigna Government Medicare Technology organization, the initial focus will be leading the Government divestiture program, which is… more
    The Cigna Group (03/04/25)
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  • Medical Director - Care Plus

    Humana (Nashville, TN)
    **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 (03/06/25)
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  • Medical Director - Southeast Region

    Humana (Nashville, TN)
    **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...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … more
    Humana (03/04/25)
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  • Physician Medical Director - LTSS

    Humana (Nashville, TN)
    …determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Director will learn National LTSS State ... community and help us put health first** The Long-term services and supports (LTSS) Medical Director 's primary responsibility is the review of medical more
    Humana (01/25/25)
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  • Field Medical Director , Cardiology

    Evolent (Nashville, TN)
    …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
    Evolent (02/14/25)
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  • Field Medical Director

    Evolent (Nashville, TN)
    …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
    Evolent (01/30/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Bowling Green, KY)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... staff services. Maintains a working knowledge of applicable national , state, and local laws and regulatory requirements affecting...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (02/06/25)
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  • Behavioral Health Medical Director

    Humana (Nashville, TN)
    …our caring community and help us put health first** The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The ... Behavioral Health Medical Director work assignments involve moderately complex...compliance and assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations,… more
    Humana (02/15/25)
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  • Field Medical Director , Radiology…

    Evolent (Nashville, TN)
    …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , you will be a key member of the utilization management team. ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
    Evolent (03/10/25)
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  • Associate Medical Director

    Evolent (Nashville, TN)
    …for the mission. Stay for the culture. **What You'll Be Doing:** **Associate Medical Director - Cardiovascular Medicine (Cardiologist) | Evolent Health** Are you ... to drive meaningful change beyond the bedside? Evolent Health is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in… more
    Evolent (03/04/25)
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  • Associate Director - Value-Based Specialty…

    Humana (Nashville, TN)
    …our caring community and help us put health first** The Associate Director - Value-based Specialty and Vendor Support role builds templates, standard documentation, ... case studies, and disseminates best in class knowledge. The Associate Director requires a solid understanding of how organization capabilities interrelate across… more
    Humana (03/04/25)
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  • Executive Director , Compliance

    NASCO (Nashville, TN)
    **Overview** As Executive Director , Compliance you will lead and provide oversight and management of Compliance and Privacy functions and serve as the company's ... Compliance Office. This role will have oversight responsibility for Medicare Advantage and ACA Exchanges strategy and executive relationship responsibility… more
    NASCO (02/11/25)
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  • Director , Competitive Intelligence, Stars

    Humana (Nashville, TN)
    …will join the Health Quality and Stars (HQS) leadership team as the Director , Competitive Intelligence to drive the strategic vision of the company's Stars ... ideal candidate will possess a deep understanding of the Medicare landscape, strong analytical skills and the ability to...field + 8+ years of work experience in large national plans, strategic consulting, market analysis and/or finance +… more
    Humana (03/04/25)
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  • Associate Director , Prepay Payment…

    Humana (Nashville, TN)
    …of our caring community and help us put health first** The Associate Director , Prepay Payment Integrity uses technology and data mining, detects anomalies in data ... the investigations of fraud waste and our financial recovery. The Associate Director , Prepay Payment Integrity requires a solid understanding of how organization… more
    Humana (03/08/25)
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  • Division Director of Reseach GME

    HCA Healthcare (Nashville, TN)
    …This position is incentive eligible. **Job Summary and Qualifications** HCA Graduate Medical Education is one of the nation's largest providers of residency and ... is building a leading network of innovative, patient-centered graduate medical education programs. We believe graduate medical ...growing to nearly 8,000 by 2028. The TriStar Division Director of Research Administration will lead a team of… more
    HCA Healthcare (03/04/25)
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  • Director of Investment Portfolio…

    Humana (Nashville, TN)
    …investments. The broad scope of transactions includes provider centric assets, Medicaid, Medicare , Homecare, and IT services. The Director of Investment ... 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 (03/04/25)
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  • Director Network Contract Coord

    Elevance Health (Nashville, TN)
    ** Director Network Contract Coord** **Location:** Alternate locations may be considered. This position will work a hybrid model (remote and office). The ideal ... 50 miles of one of our PulsePoint locations. The ** Director Network Contract Coord** is responsible for managing and...and negotiating contracts with large home health (HH), durable medical equipment (DME), large vendors and aggregators to ensure… more
    Elevance Health (03/04/25)
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  • Director , Clinical IT Technologies

    Humana (Nashville, TN)
    …and help us put health first** We are seeking an accomplished and dedicated Director of Clinical Technology Solutions to lead our Electronic Medical Records ... of clinical expertise, technological proficiency, and strong leadership abilities. The Director , Clinical Technology Solutions will own being a strategic liaison… more
    Humana (02/20/25)
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