- Elevance Health (Cincinnati, OH)
- ** Medical Director - Medicaid Appeals and Optimization (FM (with Ob experience), EM, Med/Peds, Ob/Gyn)** **Location: This is a hybrid position. Candidates must ... identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.… more
- Elevance Health (Wichita, KS)
- ** Medical Director - Kansas Medicaid ** **Location: This is a hybrid position. Candidates** **MUST** **live within 50 miles of an Elevance Health location.** ... identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Medical Director 's primary responsibility is the review of medical authorizations ... the medical necessity of a given service or level of care. The Medical Director 's work assignments involve moderately complex to complex issues where the… more
- Humana (Columbus, OH)
- …our caring community and help us put health first** The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The ... Behavioral Health Medical Director work assignments involve moderately complex...internal teaching conferences, and other reference sources * Learns Medicaid requirements and understands how to operationalize this knowledge… 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
- CVS Health (Tallahassee, FL)
- …health care more personal, convenient and affordable. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 ... Better Health of Florida primarily, and the Southeast Region (KY, LA and WV). This Medical Director will be a "Work from Home" position primarily supporting the… more
- CVS Health (Oklahoma City, OK)
- …health care more personal, convenient and affordable. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 ... opportunity with Aetna, a CVS Health company! Aetna operates Medicaid Managed Care Plans in multiple states: Arizona, California,...Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director will be a "Work from… more
- CVS Health (Austin, TX)
- …health care more personal, convenient and affordable. **Position Summary** The Behavioral Health Medical Director is a key position on Aetna Better Health of ... in market leadership and strategy meetings The Behavioral Health Medical Director will report to the Senior...and pediatric behavioral health conditions. - Experience with TX Medicaid behavioral health benefits and service. - Ability to… more
- CVS Health (Baton Rouge, LA)
- …Better Health of Louisiana is seeking a dedicated and experienced Behavioral Health Medical Director . The ideal candidate will be a board-certified psychiatrist ... of training in a medical specialty. The Behavioral Health Medical Director will ensure timely medical decisions, including after-hours consultation, and… more
- ChenMed (Columbus, OH)
- …preferred. + Strongly prefer one (1) years' previous experience as Medical Director or equivalent with a Medicare or Medicaid patient population + Board ... preferred. + Preferred to be an existing high performing PCP partner and/or Medical Director within the ChenMed core model, with a proven ability to manage a… 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 ... Medicaid Provider Services team, led by the Associate Director , is accountable for Humana's Medicaid segment...pay and a comprehensive benefits package that includes 401k, Medical , Dental, Vision and a variety of supplemental insurances,… more
- The Cigna Group (Bloomfield, CT)
- **Job Purpose/Description** The Legal Compliance Senior Director - Express Scripts Medicaid and Commercial is responsible for the development, implementation, ... the organization to identify and mitigate compliance risks. The Legal Compliance Senior Director - Express Scripts Medicaid and Commercial will serve as the… 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
- CVS Health (New York, NY)
- …health care more personal, convenient and affordable. **Position Summary** The NJ Medicaid Lead Director , Network Management is accountable for designing ... conceptual models, initiative planning, and negotiating Medicaid value based agreements with New Jersey providers, including...ability to identify and manage initiatives that improve total medical cost and quality. + Health Plan/Payer or Provider… more
- Elevance Health (Tampa, FL)
- ** Director II Medicaid State Operations** Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of ... one of our Elevance Health PulsePoint locations. The ** Director II Medicaid State Operations** is responsible for fiscal and operational management of Health… 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, clinically… more
- CVS Health (Chicago, IL)
- …new and exciting ways every day. Aetna is recruiting for an Executive Director , Medicaid Provider Experience Standardization who is responsible for ensuring the ... variations that currently exist across multiple Medicaid Health plans specific to provider contracting, credentialing, provider onboarding, loading and maintenance… more
- Elevance Health (Las Vegas, NV)
- …business hours, Monday through Friday.** **TRAVEL** **: Some travel may be required.** The Medicaid State Ops Director is an individual contributor role that is ... background. **Preferred Qualifications** + Previous experience developing and overseeing Medicaid State programs is very strongly preferred. + Masters degree… more
- New York State Civil Service (New York, NY)
- NY HELP No Agency Attorney General, Office of the Title Legal Nurse: Medical Analyst Support Medicaid Fraud Cases (6345) Occupational Category Legal Salary Grade ... Excel, and comfort with videoconferencing.Preferred Skills/Experience:* Nursing administration (eg, Director of Nursing, Administrator, Risk Manager), including current or… more