- Iowa Department of Administrative Services (Des Moines, IA)
- Medicaid Director Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/4701596) Medicaid Director Salary $149,864.00 - $212,908.80 Annually ... Department's Director , who serves on Governor Reynolds' Cabinet, Iowa's State Medicaid Director is a key member of the Iowa HHS Executive Team, responsible… more
- Humana (Des Moines, IA)
- …reference materials, internal teaching conferences, and other reference sources. Medical Director will learn National LTSS State Medicaid requirements (currently ... community and help us put health first** The Medical Director 's primary responsibility is the review of medical authorizations...obtain License/s in Indiana, Virginia, Georgia, and/or other LTSS Medicaid states as needed + MD or DO degree… more
- CVS Health (Des Moines, IA)
- …and affordable. **Position Summary** As the Manager, FP&A, you will report directly to Director of Finance and will monitor the end to end profit & loss statements, ... will assist in inquiries by both the state and the Illinois Association of Medicaid Health Plans regarding the marketshare, data submission for the purpose of rate… more
- Humana (Des Moines, IA)
- …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 ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Des Moines, IA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex clinical… more
- Humana (Des Moines, IA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex… more
- Molina Healthcare (Des Moines, IA)
- …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 quality...including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge.… more
- Humana (Des Moines, IA)
- …of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The Corporate Medical ... Director works on problems of diverse scope and complexity...+ Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Possess analysis and… more
- Humana (Des Moines, IA)
- …of our caring community and help us put health first** The Director , IT Vendor Management establishes and implements hardware and software acquisition, protection, ... and procedures that are aligned with IT standards and strategy. The Director , IT Vendor Management requires an in-depth understanding of how organization… more
- Humana (Des Moines, IA)
- …our caring community and help us put health first** The Associate Director , Cloud Architecture designs, builds, and maintains data processing architectures and ... and unstructured data to insights at enterprise scale. The Associate Director , Cloud Architecture requires an in-depth understanding of how organization capabilities… more
- Evolent (Des Moines, IA)
- …mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process,… more
- CVS Health (Des Moines, IA)
- …Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical policy implementation. ... ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on review appeal cases for denied medical services.… more
- Humana (Des Moines, IA)
- …of our caring community and help us put health first** The Director , BH Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other ... provider contracts and agreements with behavioral health providers. The Director , BH Provider Contracting requires an in-depth understanding of how organization… more
- Humana (Des Moines, IA)
- …of our caring community and help us put health first** The Associate Director , Actuarial provides actuarial support across a broad range of actuarial and business ... needs for specific product lines. The Associate Director , Actuarial requires a solid understanding of how organization capabilities interrelate across department(s).… more
- Elevance Health (Des Moines, IA)
- ** Director of Medicare Risk Adjustment Analytics and Reporting** **Location:** Alternate locations may be considered. This position will work a hybrid model (remote ... 50 miles of our Elevance Health PulsePoint locations. The ** Director of Medicare Risk Adjustment Analytics and Reporting** is...+ Experience with multiple risk adjustment models (MA, ACA, Medicaid ) and markets preferred + Familiarity with Star and… more
- Evolent (Des Moines, IA)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , you will be a key member of the utilization management team. We can offer ... timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation,… more
- United Therapeutics (Des Moines, IA)
- …orphan diseases. **How you'll contribute** The Associate Analytics, Insights and Operations Director , Market Access will lead data support across all functions of ... + Scrub 340B claims data and identify duplicate discounts with commercial, Medicaid , and Medicare rebate payments + Support GTN forecasting and collaborate with… more
- Primary Health Care (Des Moines, IA)
- …have locations in Ames, Des Moines, & Marshalltown. As a Patient Services Director , you will manage the beginning phases of PHC's revenue cycle. PSD collaborates ... + Maintains knowledge of current health benefit options and practices, Medicaid , Medicare, Commercial Insurance, sliding fee discount program, and outreach along… more
- Molina Healthcare (Des Moines, IA)
- …tools, and presents healthcare utilization and cost containment reports across Medicaid , LTSS, Medicare, and Marketplace, and makes recommendations based on relevant ... findings. **Knowledge/Skills/Abilities** Directs Health Plan strategic analysis and planning coordinating across business units to meet financial data analysis needs. * Mentors, coaches, and provides guidance regarding finance and analysis. * Identifies and… more
- Molina Healthcare (Des Moines, IA)
- …and medical claims * Knowledge of HMO, PPO, POS, MCO, Medicare, Medicaid , Market Place products, laws, rules and regulations **Preferred Education** * Master's ... degree **Preferred Experience** * Formalized training/experience in Health Care Insurance Fraud * Experience with Power BI, SAS, SQL other reporting software * ICD-10 CPT-4, HCPCS coding **Preferred License, Certification, Association** Professional… more