- Highmark Health (Austin, TX)
- …current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and ... **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions,… more
- Humana (Austin, TX)
- …of providing frameworks to maximize available resources to achieve growth. The ** Director ,** ** Medicaid Insurance Product Management and Wellness Strategy** will ... caring community and help us put health first** Humana Medicaid is seeking exceptional candidates to join our ...(10-25% of time) This position is open to working remote within the US but prefer the qualified candidate… more
- Humana (Austin, TX)
- …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 ... understanding of how organization capabilities interrelate across the function or segment. The Director , Actuarial of Medicaid Pricing may be responsible for any… more
- Magellan Health Services (Dallas, TX)
- …MMUM). After Hours coverage may be required. General Job Information Title Medical Director , BH - TX licensed, Remote (part time) Grade 36 Work Experience - ... for the health plan(s) for all lines of business ( Medicaid , Medicare, and Commercial) and implements programs to support...activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May… more
- Prime Therapeutics (Austin, TX)
- …our passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions -RPH/PharmD required- REMOTE **Job Description ... Summary** Responsible for support and development of Medical Pharmacy program strategy as part of the Medical Pharmacy Specialty Clinical Solutions team.… more
- Humana (Austin, TX)
- …a part of our caring community and help us put health first** Director of Enterprise Information Protection (EIP) Cybersecurity Engineering focused on building a ... decentralized systems. * Google Cloud Professional Machine Learning Engineer * Agile Remote /WAH requirements: + WAH requirements: Must have the ability to provide a… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Austin, TX)
- …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...+ Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate… more
- Providence (Lubbock, TX)
- **Description** **_This position is remote . Eligible states include: WA, OR, CA, TX, NM, MT, and AK._** Reporting to the VP of Revenue Cycle Services Market ... Operations, the Executive Director , Financial Counseling is accountable for the enterprise state...Oversee Patient Financial Counseling functions. + Oversee and monitor Medicaid Pillar results, ensure appropriate action items are in… more
- Humana (Austin, TX)
- …strong business results and does so efficiently and effectively. **Location:** remote The Director , Strategy Advancement provides data-based strategic direction ... community and help us put health first** The Health Quality & Stars, Medical Cost Management, and Clinical Analytics organization is looking for a seasoned leader… more
- Mindoula Health (TX)
- …company that identifies, engages, and serves populations with complex behavioral health, medical , and social challenges across the continuum of care. By using ... most complex and underserved behavioral health populations. The Program Director of the Substance Use Disorders Program is the...yielding desired outcomes. Location + This position is 100% remote . + This job operates in a remote… more
- HealthEdge Software Inc (Austin, TX)
- …to solve critical needs in healthcare. This individual will report to the Chief Medical Officer of Healthedge (HE) and ensure that our clinical suite of products ... Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other...Work across multiple time zones in a hybrid or remote work environment. + Long periods of time sitting… more
- Elevance Health (Grand Prairie, TX)
- **Process Improvement Director -Enterprise HEDIS** **Location:** This position will work a hybrid model ( remote and office). Must reside within 50 miles/1hour ... commute from an Elevance Health location. The **Process Improvement Director -Enterprise HEDIS** is responsible for identifying opportunities for improvement,… more
- Elevance Health (Grand Prairie, TX)
- **Program Director , LTSS Value Based and Workforce Initiatives** **Location:** This position will work a hybrid model ( remote and office). The ideal candidate ... 50 miles of one of our Elevance Health PulsePoint locations. The **Program Director , LTSS Value Based and Workforce Initiatives** position is part of the national… more
- Cardinal Health (Austin, TX)
- …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
- CVS Health (Austin, TX)
- …health care more personal, convenient and affordable. **Position Summary** As the Director of Commercialization and Growth, part of the Health Care Delivery business ... sales strategies and growth objectives. Note**:** _This is a remote role and can be anywhere in the continental...Experience in Managed Care space (Medicare Advantage or Managed Medicaid ) a plus. + Knowledge of health plan economics… more
- BrightSpring Health Services (Lubbock, TX)
- …compliance with Company policies and procedures, state licensure and regulations, Medicaid and Medicare standards, as well as state reimbursement regulations + ... nursing and direct care staff, family and/or guardians, and community medical providers and professional consultants in cooperation with operations management +… more
- Prime Therapeutics (Austin, TX)
- …every decision we make. **Job Posting Title** Pharmacy Network Manager - Remote **Job Description** The Pharmacy Network Manager is responsible for development and ... industry; including 3 years of managed care experience in medical or pharmacy network contracting + Must be eligible...+ Knowledge of and experience within health care/PBM industry, Medicaid , Medicare and health plans + Familiarity with contract… more
- Molina Healthcare (Port Arthur, TX)
- **_ Remote and must live in Harris or Jefferson County _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for ... between Molina Healthcare and contracted provider network. In partnership with Director , manages and coordinates the Provider Services activities for the state… more
- American Heart Association (Dallas, TX)
- …organizations supporting measure surveillance, workgroup nominations, and comments. Supports the Director of Quality and Health IT to further the department's ... Participates in the national measure and registry committees as determined by the Director of Quality and Health IT. Works with the NQF endorsement process. The… more