- Humana (Washington, DC)
- …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
- Somatus (Mclean, VA)
- …and mental well-being + Community engagement opportunities + And more! The Sr. Director , Medicare Risk Adjustment (MRA) will lead the execution strategy and ... the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Flexible Paid Time Off (PTO) + Professional… more
- Humana (Washington, DC)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify … more
- Humana (Washington, DC)
- …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 (Washington, DC)
- **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 (Washington, DC)
- **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 (Washington, DC)
- **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 (Washington, DC)
- **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
- AbbVie (Washington, DC)
- …guidance to inform launch planning and label changes for AbbVie products. Provide national reimbursement policy research related to Medicare to inform and ... medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's… more
- Evolent Health (Washington, DC)
- …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
- Evolent Health (Washington, DC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director - Physical Health, you will be a key member of the utilization ... jeans. **Collaboration Opportunities:** Evolent is looking for a Field Medical Director to be a member of...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- VHC Health (Arlington, VA)
- OB Medical Director Job Description Purpose & Scope: The physician is a member of the healthcare team who works in collaboration with other staff to provide ... is required. VHC Health Hospital is seeking a visionary Medical Director to lead our Labor and...proud member of the Mayo Clinic Care Network (a national network of independent healthcare organizations). + VHC Health… more
- VHC Health (Arlington, VA)
- Medical Director - Palliative Care Job Description Purpose & Scope: The physician is a member of the healthcare team who works in collaboration with other staff ... objectives, budget, and performance metrics at the individual level.Supports all medical activities at the individual level including implementation of quality… more
- Gilead Sciences, Inc. (Washington, DC)
- …the lives of patients with life-threatening illnesses worldwide. As the **Senior Director , Field Reimbursement Management (FRM)** for HIV Prevention, you will play a ... with pharmacy benefits, specialty payer landscape, and reimbursement pathways (commercial, Medicare , Medicaid). + An understanding of local and state policy changes'… more
- Humana (Washington, DC)
- …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
- Humana (Washington, DC)
- …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 (Washington, DC)
- …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
- Humana (Washington, DC)
- …you ready to lead a transformative journey in the insurance segment as an Associate Director of IT Finance? This is your opportunity to make a significant impact by ... of IT within the insurance sector! **Job Description** The Associate Director , Financial Analytics collates, models, interprets and analyzes data to identify,… more
- Humana (Washington, DC)
- …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 (Washington, DC)
- …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