- 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)
- …help us put health first** Humana Healthy Horizons is seeking an Associate Director , Medicaid Implementation (Business Project Management) to lead within a ... and project management are best suited for this role. The Associate Director , Medicaid Implementation (Business Project Management) will provide oversight to… more
- Humana (Des Moines, IA)
- …business. The Quality Improvement Program Lead reports directly to the National Medicaid Quality Director . The Quality Improvement Program Lead exercises ... oversight of Humana's QI programs management model and improvement strategy for the Medicaid line of business at the national level. + Develops policy and procedure,… more
- Highmark Health (Des Moines, IA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic… 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
- Humana (Des Moines, IA)
- …a part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). ... The Medical director work assignments involve moderately complex to complex issues...medical management review organization such as Medicare Advantage, managed Medicaid , or Commercial health insurance + Experience with national… more
- Humana (Des Moines, IA)
- …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 scope and complexity...+ Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate… more
- Evolent Health (Des Moines, IA)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you will be a key member of the utilization ... + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into the types of...state or federal health care program, including Medicare or Medicaid , and is not identified as an "excluded person"… 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
- Prime Therapeutics (Des Moines, IA)
- …drives every decision we make. **Job Posting Title** Clinical Program Development Director , Stars - Remote **Job Description** The Clinical Program Development ... Director contributes to the development of drug management strategy...align activities around a specific line of business (MedD, Medicaid , Health Insurance Marketplace, Commercial). **Responsibilities** + Serve as… more
- Humana (Des Moines, IA)
- …caring community and help us put health first** The Associate Director , Actuarial Analytics/Forecasting analyzes and forecasts financial, economic, and other data ... medium and long-term financial and competitive position. The Associate Director , Actuarial Analytics/Forecasting requires a solid understanding of how organization… more
- Humana (Des Moines, IA)
- …of our caring community and help us put health first** The Director , Technology Solution Implementation delivers new technological solutions to meet business needs ... within a specified scope while aligned to enterprise objectives. The Director , Technology Solution Implementation requires an in-depth understanding of how… more
- Conviva (Des Moines, IA)
- …of our caring community and help us put health first** The Associate Director , Security Architecture will play a key role in implementing security architecture, ... ensure the enterprise can achieve the enterprise security strategy. The Associate Director , Security Architecture will play a key role in implementing security… more
- Prime Therapeutics (Des Moines, IA)
- …our passion and drives every decision we make. **Job Posting Title** Sr. Director , Pharmacy Network Management - Remote **Job Description** The Senior Director ... Qualifications** + MBA,othergraduatework,orequivalenttrainingand/orexperience + IntimateknowledgeofandexperiencewithinthePBMindustry, Medicaid ,Medicare,andhealthplans + Familiaritywithcontractlanguageandriskmitigationconcepts +… more
- Cardinal Health (Des Moines, IA)
- …onsite staff. This is an individual contributor role that reports to the Sr. Director of Clinical Operations. Candidates can live anywhere in the United States but ... + Strong working knowledge of the intersection of 340B and Medicaid , including duplicate discounts, fee-for-service versus managed care, medical versus pharmacy,… more
- Prime Therapeutics (Des Moines, IA)
- …passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description Summary** ... (eg, URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQA-National Committee for Quality Assurance, and ERISA-Employee… more
- Public Consulting Group (Des Moines, IA)
- …intersection and overlap between our Special Education/Case Management and school-based Medicaid services work within a state; regularly engage with counterparts + ... clients + Understand and continually monitor Federal, state, and local Medicaid School-Based program policies and guidance, collaborating with PCG subject matter… more
- Southeast Polk Community School District (Altoona, IA)
- …to record Medicaid billing information at the direction of the director of special education. + Maintain confidentiality on sensitive information. + Other duties ... + Previous supervisory experience. Reports to: Building Principal or Department Director Job Goal:The performance responsibilities as shown below represent only the… more