- Elevance Health (Buffalo, NY)
- ** Medicaid Quality Management Director ** Location: This position will work a hybrid model (remote and office). The candidate must live within 50 miles of ... the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan.… more
- Humana (Columbus, OH)
- …and help us put health first** Humana Healthy Horizons is seeking an Associate Director , Medicaid Implementation (Business Project Management ) to lead within ... are best suited for this role. The Associate Director , Medicaid Implementation (Business Project Management...need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …the Chief Financial Officer for Medicaid and is a member of the Medicaid Director 's Executive Team. The CFO provides direction and support to the following ... rate setting. Level of Work: Administrator. Supervision Received: Broad direction from Medicaid Director . Supervision Exercised: Direct line over Section Chiefs… more
- Humana (Columbus, OH)
- …and help us put health first** Humana Healthy Horizons is seeking an Associate Director , Medicaid Provider Services to serve in a strategic leadership role ... segment. The Medicaid Provider Services team, led by the Associate Director , is accountable for Humana's Medicaid segment strategy and operationalizing the… more
- CVS Health (Raleigh, NC)
- …health care more personal, convenient and affordable. **Position Summary** The Lead Director , Network Management - Medicaid /North Carolina is accountable ... for designing conceptual models, initiative planning, and negotiating Medicaid value based agreements with North Carolina providers, including health systems,… more
- Elevance Health (Tampa, FL)
- …network development, provider partnerships, provider relations, medical management , case management and quality management programs, performance ... ** Director II Medicaid State Operations** Location:...management of Health Plan various lines of business ( Medicaid and Florida Healthy Kids). **How you will make… more
- CVS Health (Austin, TX)
- …Medical Leadership, Pharmacy Director , clinical staff (including those in utilization management , care management , quality management ), and ... agencies, providers, and key community partners to oversee the quality of the ABHT BH program and the implementation...management performance and coordination with physical health care management . - Participation in HHS medical director … more
- CVS Health (Princeton, NJ)
- …in a New Jersey or New York office location **Position Summary** The position of Lead Director , CFO, New York & New Jersey, will function as the CFO for both the New ... York & New Jersey Medicaid Health Plan's and will lead the respective markets'... Agency. + Leverage prior experience to ensure the quality and integrity of P&L/cost center owner level reporting,… more
- CVS Health (Baton Rouge, LA)
- …Medical Leadership, Pharmacy Director , clinical staff (including those in utilization management , care management , quality management ), and ... of Louisiana is seeking a dedicated and experienced Behavioral Health Medical Director . The ideal candidate will be a board-certified psychiatrist with a current,… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …and grant administration. Conducts investigations and makes recommendations for the Medicaid Director 's response to grievances by Field Operations staff. ... dedicated to fulfilling its mission through direct provision of quality services, the development and stimulation of services of... Medicaid program(s) and supervision exercised. Differs from Medicaid Deputy Director by the absence of… more
- New York State Civil Service (Orangeburg, NY)
- …Health, Office of Title Deputy Director , Psychiatric Center 1 - Quality Management , M-4, Rockland Children's Psychiatric Center, P25678 Occupational Category ... eligible to participate in Federal health care programs (eg, Medicaid ). Individuals excluded from participation in these programs will...a Deputy Director , Psychiatric Center 1 - Quality Management (DDPC 1 - QM) to… more
- Dignity Health (Bakersfield, CA)
- …is remote and will work across multiple time zones.** **Position Summary:** The Director , Quality Management Population Health Services Organization (PHSO) ... types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care management pathways. Dignity Health MSO is… more
- Humana (Columbus, OH)
- …analytic and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management...size of region or line of business. The Medical Director conducts Utilization Management of the care… more
- CVS Health (Springfield, IL)
- …successful track record negotiating contracts which includes experience within Network Medicaid management . Proven working knowledge of provider financial issues ... health care more personal, convenient and affordable. **Position Summary** The Lead Director will manage the development of contracts and agreements with providers… more
- City of New York (New York, NY)
- …care delivery systems comprised of Managed Care Organizations (MCOs) and case management providers through which eligible Medicaid clients access behavioral and ... areas: Managed Care Client Services (MCCS), Recipient Restriction Program (RRP), and Comprehensive Medicaid Case Management (CMCM). These areas work with the New… more
- CVS Health (Sacramento, CA)
- … Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and ... Directors will participate in inter-rater review activities and other quality oversight processes for internal Director UM...in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior… more
- Centers for Independence (Fond Du Lac, WI)
- **Associate Director - Quality , Systems & Customer Experience** **Job Details** **Job Location** iLIFE Main - Milwaukee, WI **Position Type** Full Time ... **Job Category** Nonprofit - Social Services **Description** **Job Purpose:** The Associate Director of Quality . Systems & Customer Experience promotes optimal… more
- LifePoint Health (Rutherfordton, NC)
- …and knowledge and experience operating community hospitals and healthcare organizations. The Director of Case Management is responsible for the oversight of ... * The Director is responsible for the overall direction and management of these areas, including planning, organizing and directing all activities, staffing,… more
- CareFirst (Baltimore, MD)
- …based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the utilization ... for the design, assessment, implementation and outcomes of utilization management strategies using a multidisciplinary approach to enhance member engagement,… more
- CVS Health (Hartford, CT)
- …of our members' health care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing and deploying ... of the Dual Eligible Special Needs Plan (DSNP) and Medicare- Medicaid Plan (MMP) care management teams and...and socioeconomic needs. * Partner closely with the Executive Director of Duals and other Duals Care Management… more