- CVS Health (Austin, TX)
- …based (work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part ... encumbrances * Board Certified in ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals… more
- Molina Healthcare (Dallas, TX)
- …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
- 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...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Elevance Health (Grand Prairie, TX)
- …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
- Humana (Austin, TX)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and support staff… 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 ... 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 (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 ... 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 (Austin, TX)
- **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
- Evolent Health (Austin, TX)
- …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
- Ascension Health (Austin, TX)
- …**Schedule** :TBA + **Practice** **Detail** : Ascension Texas has an immediate opening for a Medical Director of Population Health who will serve as a member of ... We are seeking to recruit a full time, practicing Medical Director of Population Health to serve...Care Organizations participating in the Enhanced Track of the Medicare Shared Savings Program, multiple commercial value-based models and… more
- Magellan Health Services (Dallas, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead senior medical director , and quality improvement staff. May participate in various ... the health plan(s) for all lines of business (Medicaid, Medicare , and Commercial) and implements programs to support this...committees or project teams as directed by the senior medical director or vice-president. + Supports senior… more
- CVS Health (Austin, TX)
- …transformation, and administrative support. CVS Accountable Care is seeking an Executive Director , Payor Medical Economics to join our growing organization. In ... business, is a strategic partner in value-based care serving more than 1M Medicare beneficiaries, and over 60K provider partners across 230 clients in ACO REACH,… more
- CenterWell (Austin, TX)
- …The Associate Director , Risk Adjustment oversees quality assurance audits of medical records, ICD-10-CM, CPT, & HCPCS codes that are submitted to the Centers ... for Medicare and Medicaid Services (CMS), other payers, and over...payers, and over government agencies. In addition, the Associate Director , Risk Adjustment oversees all medical coding… more
- CVS Health (Austin, TX)
- …beneficiary health and experience, drive quality, create clinical efficiencies, and control medical costs. In addition, the Executive Director of Population ... The Executive Director of Population Health reports to the Chief Medical Officer and is accountable for achieving business results in areas of responsibility… more
- HCA Healthcare (San Antonio, TX)
- …environment where diversity and inclusion thrive? Submit your application for our Director of Rehab Services opening with Methodist Hospital Metropolitan today and ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...benefits may vary by location._** We are seeking a(an) Director of Rehab Services for our team to ensure… more
- Humana (Austin, TX)
- …us put health first** Humana Healthy Horizons is seeking an Associate Director , Medicaid Implementation (Business Project Management) to lead within a specific ... and project management are best suited for this role. The Associate Director , Medicaid Implementation (Business Project Management) will provide oversight to the… more
- CVS Health (Irving, TX)
- …on high-value medical rebate contracts and value based agreements for Medicare Part B, Managed Medicaid, and Commercial segments. This includes management of the ... lowering costs and improving quality of care. In this Director level role, you will have the opportunity to...PBM industry + Strong knowledge and understanding of pharmaceutical medical rebates, buy and bill, and/or Medicare … more
- Humana (Austin, TX)
- …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
- UTMB Health (Galveston, TX)
- …+ Participates in long-term planning of management activities with the Administrative Director , the Medical Directors and the Division Managers. Evaluates ... Assistant Administrative Director , Laboratory Services **Galveston, Texas, United States** Clinical...programs. Initiates appropriate action. + Works in conjunction with medical staff, nursing, ancillary personnel, and senior hospital management… more
- HCA Healthcare (San Antonio, TX)
- …and wait list volumes and spin-off activity. + Works effectively with program Medical Director , ensuring strong lines of communication and follow-up, and jointly ... want to join an organization that invests in you as a(an) Administrative Director of Bone Marrow Transplant? At Methodist Hospital, you come first. HCA Healthcare… more