- Pacer Staffing (Atlanta, GA)
- …plan. Prepares and presents cases involving high-profile or sensitive issues to the Medical Director for review. Functions as an advocate for the beneficiary ... Shift - Standard | Mon to Fri Location - Remote (Case Manager - serious diagnoses. Children/Pediatric with down...particular to the ECHO according to policy, collaborating with Medical Directors as needed. ECHO Case Managers serve as… more
- Highmark Health (Columbus, OH)
- …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 (Columbus, OH)
- …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 (Columbus, OH)
- …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
- Providence (OR)
- …them._** **Providence Health Plan is calling an Community Enrollment Services Specialist, Medicaid who will:** + Educate and assist community members in obtaining ... location and compensation range in Salem, Oregon **Providence Health Plan welcomes 100% remote work for residents who reside in the following States:** + Oregon… more
- Motion Recruitment Partners (Canton, MA)
- Project Manager - Medicaid Canton, Massachusetts **Open to Remote ** Contract $65/hr - $65/hr Our client is looking for a contract Project Manager - Medicaid . ... to Canton, MA. However, the client is amenable to remote work as long as the candidate resides in...in CST or EST. As the Project Manager - Medicaid , you will be the driving force behind the… 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
- CVS Health (Richmond, VA)
- …involved in local communities and leading the way in health care. The LTSS Director , Clinical Health Services ( Director ), will partner closely with the LTSS ... CEO, DSNP Senior Leadership Clinical Health Services, Centers for Medicare and Medicaid Services, and State Agencies to build a transparent and trusting… more
- AbbVie (Chicago, IL)
- …on LinkedIn. Allergan Aesthetics | An AbbVie Company Job Description Associate Director , Market Access and Advocacy- Plastic Regenerative Medicine, will focus on the ... will call on commercial payors, managed care organizations, Medicare MACs, state Medicaid , Medicare Advantage and commercial plans to increase coverage of PRM… more
- CareFirst (Baltimore, MD)
- …compliance, population health, and/or member/provider experience. + Analyzes Medicare and Medicaid pharmacy and medical drug utilization data to identify ... **Resp & Qualifications** **PURPOSE:** Director , Pharmacy Government Programs is responsible for implementing...vision and strategic plan for government programs (Medicare and Medicaid ). This role has oversight of pharmacy staff and… more
- Prime Therapeutics (Columbus, OH)
- …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 (Columbus, OH)
- …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
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Not a Remote Position Position Purpose: This leadership position is responsible for the development, implementation and oversight of the Quality Improvement Program, ... member of the Quality Improvement Committee, Appeals and Grievance Committee, and Medical Management Committee. + Responsible for quarterly reporting to the Quality… more
- Humana (Columbus, OH)
- **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
- WellSense (Boston, MA)
- …Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, ... Director of Finance and Strategy, MassHealth Product WellSense...the WellSense ACO and MCO programs under the Massachusetts Medicaid product known as MassHealth. WellSense's MassHealth enrollment includes… more
- Humana (Columbus, OH)
- …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
- AmeriHealth Caritas (Newark, DE)
- ** Medical Director , LTSS (must reside in DE)** Location: Newark, DE Primary Job Function: Medical Management ID**: 34195 **Job Brief** Qualified candidates ... and related policy and practice initiatives in collaboration with the Corporate Medical Director (s), Senior Medical Directors, Utilization Management and… more
- Magellan Health Services (Albuquerque, NM)
- …Commercial) and implements and manages programs to support this vision. The Senior Medical Director ensures the delivery of appropriate health care by overseeing ... This position is remote in New Mexico, candidates must be NM...physician advisors. Ensures adequate physician resources. Develops and manages medical director and physician advisor budgets, travel… more
- Humana (Indianapolis, IN)
- …of our caring community and help us put health first** The Associate Director , Care Management leads teams of nurses and behavior health professionals responsible ... for care management. The Associate Director , Care Management requires a solid understanding of how...Bachelor's Degree. + 5+ years of professional experience in Medicaid and/or Medicare managed care operations, case management, or… more
- Teva Pharmaceuticals (Parsippany, NJ)
- Associate Director , Strategic Pricing - Parsippany, NJ Date: Sep 7, 2024 Location: Parsippany, United States, New Jersey, 00000 Company: Teva Pharmaceuticals Job Id: ... with. **The opportunity** The primary role of the Associate Director , Strategic Pricing is to coordinate pricing activities and...subject matter expert on gross to net sales, the Medicaid Drug Rebate Program, and the 340B Drug Pricing… more
