- Humana (Richmond, VA)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of… more
- Humana (Richmond, VA)
- …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. ... The Behavioral Health Medical Director work assignments involve moderately complex...conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare… more
- Humana (Richmond, VA)
- …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 reviews cases of diverse scope...rendered by healthcare professionals in compliance with CMS guidelines, clinical coverage criteria, and quality standards. Represents Humana at… more
- Elevance Health (Richmond, VA)
- **Anticipated End Date:** 2024-09-23 **Position Title:** Pharmacy Account Director , Medicare **Job Description:** A proud member of the Elevance Health family of ... (formerly IngenioRx) leverages the power of new technologies and a strong, clinical -first lens, to deliver member-centered, lasting pharmacy care. In this pivotal… more
- Somatus (Mclean, VA)
- …and mental well-being + Community engagement opportunities + And more! The Sr. Director , Medicare Risk Adjustment (MRA) will lead the execution strategy and ... the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Flexible Paid Time Off (PTO) + Professional… more
- CenterWell (Richmond, VA)
- …part of our caring community and help us put health first** The National Director , Clinical Pharmacy is a strategic pharmacy leader responsible for developing, ... Medical Officer. This role reports to the National Director , High Risk Patient Management. Responsibilities will include: +...(SME) and clinical liaison to the national clinical leadership (including Chief Medical Officer, Complex… more
- Prime Therapeutics (Richmond, VA)
- …our passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description ... Medical Pharmacy clients and potential new clients. Required to serve as a Medical Pharmacy clinical resource throughout the organization and support all … more
- Humana (Richmond, VA)
- **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...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … more
- Humana (Richmond, VA)
- … Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert ... caring community and help us put health first** The Medical Director actively uses their medical...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … more
- CVS Health (Richmond, VA)
- …opportunity for a Medical Director ( Medical Affairs). The Medical Affairs department provides clinical business support to the entire enterprise and ... Fortune 4 company, has an outstanding opportunity for a Medical Director - Medical Affairs....need a Board Certified Oncologist for this opportunity. The Medical Affairs department provides clinical business support… more
- Humana (Richmond, VA)
- **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
- Elevance Health (Richmond, VA)
- …reviews within our Medicaid and Medicare programs.** The **Behavioral Health Medical Director ** is responsible for the administration of behavioral health ... of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative...an entire clinical program and/or independently performs clinical reviews. + The Medical Director… more
- CVS Health (Richmond, VA)
- …clinical coverage and policies. **Primary Job Duties & Responsibilities:** Behavioral Health Medical Director + Collaborates with health plan Sr Leadership to ... directors to ensure the delivery of holistic and integrated person-centered care. The Medical Director will be responsible for provider education regarding best … more
- VHC Health (Arlington, VA)
- Medical Director - Palliative Care Job...programs.The role of a physician is to provide quality clinical care to those individuals who have chosen VHC ... budget, and performance metrics at the individual level.Supports all medical activities at the individual level including implementation of...in the region that was named a Center for Medicare & Medicaid Services Four-Star Hospital, and is also… more
- CVS Health (Richmond, VA)
- …closely with the LTSS Executive Director , Market CEO, DSNP Senior Leadership Clinical Health Services, Centers for Medicare and Medicaid Services, and State ... and leading the way in health care. The LTSS Director , Clinical Health Services ( Director ),...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… more
- Sunrise Senior Living (Arlington, VA)
- …big breath of fresh air."_** **_- Sunrise Leader_** At Sunrise, our Assistant Director of Nursing Services is responsible for providing assistance and supervision of ... the clinical care and services to residents in the skilled...consistent delivery of quality resident services - Assisting the Director of Nursing Services (DNS) in maintaining the skilled… more
- Humana (Richmond, VA)
- …They will lead and guide others in providing integrated services for the clinical teams. The Associate Director , Care Management requires a solid understanding ... health first** Humana Healthy Horizons in Virginia is seeking an Associate Director , Care Management (LTSS/ABD) who will lead teams of healthcare professionals… more
- HealthEdge Software Inc (Richmond, VA)
- …to solve critical needs in healthcare. This individual will report to the Chief Medical Officer of Healthedge (HE) and ensure that our clinical suite of ... them: NCQA (National Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other… more
- Prime Therapeutics (Richmond, VA)
- …and drives every decision we make. **Job Posting Title** Trade Client Strategy Director - Remote **Job Description** The Trade Client Relations Director is ... responsible for the analysis, modeling and delivery of innovative pharmacy and medical rebate strategies and cost saving solutions to Prime's clients to ensure Prime… more
- Cardinal Health (Richmond, VA)
- …team is passionate about helping oncology practices navigate the future. The Director , Managed Care is responsible for strategy and management of managed care ... responsible to implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing… more