- Elevance Health (Louisville, KY)
- ** Medicare Medical Director ** Location: This position will work a hybrid model (remote and office). The ideal candidate will must live within 50 miles of one ... Candidates must be able to work Eastern Time Zone hours. The ** Medicare Medical Director ** is responsible for the administration of physical and/or… more
- CVS Health (Louisville, KY)
- …is compliantly and effectively operating in the market. As such, the Lead Director of Medicare Operations supports MAPD and SNP initiatives and implements ... personal, convenient and affordable. **Position Summary** In support of the Chief Medicare Officer, the candidate has responsibility for ensuring that the local … more
- Molina Healthcare (Louisville, KY)
- …quality 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...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Louisville, KY)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... State Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- CommuniCare Health Services Corporate (Corydon, IN)
- Medical Director - Physician Since 1984, CommuniCare Health Services has provided superior, comprehensive management services for the development and management ... Indiana, West Virginia, Virginia, Missouri, Pennsylvania and Maryland. As Medical Director , you will be part of...+ Health care management/leadership experience + Familiarity with CMS, Medicare Advantage, SNP Rules and Regulations + HCC and… more
- ChenMed (Louisville, KY)
- …preferred. + Strongly prefer two (2) 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
- Signature Healthcare (Louisville, KY)
- …Plan of Care for each resident in coordination with the physician, Medical Director , nursing staff, and outside consultants (ie, nursing, dietary, ... 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded...Modern Healthcare's "Best Places to Work!" Overview The ideal Director of Nursing Candidate is very detailed orientated, organized,… more
- Signature Healthcare (Louisville, KY)
- …facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded as a certified Great ... and Modern Healthcare's "Best Places to Work!" Overview The ideal Assistant Director of Nursing Candidate is very detailed orientated, organized, great knowledge of… more
- Signature Healthcare (Louisville, KY)
- …facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded as a certified Great ... Modern Healthcare's "Best Places to Work!" Overview The ideal Director of Nursing Float Candidate is very detailed orientated,...and Signature Perks include the following and more! + Medical , Dental and Vision - Voluntary Life/Disability + 401(K)… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview Director of Clinical Denials Management and Audit supervises a team of RN/LPN clinical reviewers as well as Support ... appeal utilizing relevant and effective clinical documentation from the medical record; supported by current industry clinical guidelines, evidence-based medicine,… more
- Waystar (Louisville, KY)
- **ABOUT THIS POSITION** A Waystar Regional Director must effectively communicate with target account senior leaders and executives, and coordinate strategy with ... systems, and is connected to over 5K commercial and Medicaid/ Medicare payers. We are deeply committed to living out...+ bonus, if applicable) + Customizable benefits package (3 medical plans with Health Saving Account company match) +… more
- Signature Healthcare (Louisville, KY)
- …facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded as a certified Great ... "Best Places to Work!" Overview As the Social Services Director you will identify and provide for each resident's...and Signature Perks include the following and more! + Medical , Dental and Vision - Voluntary Life/Disability + 401(K)… more
- Molina Healthcare (Louisville, KY)
- …Access, Word and Excel * Knowledge and understanding of claims processing systems 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,… more
- CenterWell (New Albany, IN)
- …participant and lead with the care team through daily huddles. . Helps Regional Medical Director (RMD), Physician and Center Administrator in setting a tone of ... Appropriate certification to write prescriptions under the authority of a collaborating physician/ medical director . + This role is considered patient facing and… more
- CenterWell (New Albany, IN)
- … medical expertise with the care team through daily huddles. . Helps Regional Medical Director and Center Administrator in setting a tone of cooperation in ... Doctors, Advanced Practice professionals, Pharm D, Care Coach Nurses, Medical Assistants, Behavioral Health, Specialists, Quality Based Coders, Referral Coordinators… more
- CenterWell (Clarksville, IN)
- … medical expertise with the care team through daily huddles. . Helps regional medical director and center administrator in setting a tone of cooperation in ... doctors, advanced practice professionals, pharm D, care coach nurses, medical assistants, behavioral health, specialists, quality-based coders, referral coordinators… more
- Elevance Health (Louisville, KY)
- …records of denied services for medical necessity + Extrapolates and summarizes medical information for medical director , consultants, and other external ... Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare...+ Conducts investigations and reviews of member and provider medical necessity appeals + Reviews outpatient Medicare … more
- CenterWell (Louisville, KY)
- …audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers ... of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. +… more
- Waystar (Louisville, KY)
- …to highly useable software. This professional self-starter will report to a Director , Product Management and work closely with User Experience team and Technology ... needs and ensure customer satisfaction and product quality + Assisting your Director of Product Management in coordinating with sales, marketing, development, and… more
- Sellersburg Healthcare Center (Sellersburg, IN)
- …BOM. The BOM must be able to effectively communicate with the Executive Director , Regional Team, and Business Office Staff as well as interact effectively with ... and management training. + Must possess a thorough understanding of Medicare . Medicaid, Private Insurance, Managed Care costing and analysis, personnel management,… more