- Humana (Santa Fe, NM)
- …or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical ... caring community and help us put health first** The Medical Director relies on medical ...or Surgery specialties + Utilization management experience in a medical management review organization, such as Medicare … more
- Humana (Santa Fe, NM)
- …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 works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Santa Fe, NM)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify … more
- Humana (Santa Fe, NM)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… more
- Humana (Santa Fe, NM)
- **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
- Humana (Santa Fe, NM)
- **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
- CVS Health (Santa Fe, NM)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...and consistent responses to members and providers. As a Medical Director you will focus primarily on… more
- Humana (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …and help us put health first** The Clinical Pharmacy Provider Engagement Associate Director , HPS Clinical Program Strategy, partners with Medicare Leadership to ... in-depth understanding of how organization capabilities interrelate across the PBM, Medicare segment, and provider organizations. The effective candidate must have… more
- Humana (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …legislative/oversight bodies (eg, URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQA- National Committee for ... passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description Summary**… more
- Humana (Santa Fe, NM)
- …a part of our caring community and help us put health first** Associate Director , Enterprise API Standards and Governance is a pivotal role in leading the technology ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
- Humana (Santa Fe, NM)
- …health first** Humana's Marketing organization is seeking a dynamic and experienced Director , Campaign Planning & Orchestration Leader to join our team. This leader ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
- Humana (Santa Fe, NM)
- …of providing frameworks to maximize available resources to achieve growth. The ** Director ,** **Medicaid Insurance Product Management - Growth & Innovation** will be ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
- Evolent Health (Santa Fe, NM)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients,… more
- Humana (Santa Fe, NM)
- …organizations in the country. The Healthcare Strategy team supports Humana's Medicare and Medicaid business unit. This business unit, Humana's largest, comprises ... experience leveraging core consulting skills to support delivering some of Medicare and Medicaid's highest priority projects and initiatives, with an emphasis… more
- Evolent Health (Santa Fe, NM)
- …on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization ... as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures...support. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Prime Therapeutics (Santa Fe, NM)
- …of utilization management decisions. + On a requested basis, may function as Medical Director for select health plans or regions, assuming overall accountability ... member of the utilization management team, and provides timely medical review of service requests that do not initially... Affairs. + Other duties as assigned. **Responsibilities** + Medicare Part D experience preferred. + Doctor of Medicine… more
- Public Consulting Group (Santa Fe, NM)
- …will support the public safety consulting business line, and other Medicaid and Medicare related projects. This role will use knowledge of fire/emergency medical ... fire departments and/or EMS agencies at the chief officer or manager/ director level. Provenexperience with people management, strategic planning, risk management,… more
- Humana (Santa Fe, NM)
- …The Senior Marketing Campaign Manager reports directly to the Associate Director , Portfolio & Campaign Management and is responsible for end-to-end management ... starting your FIRST day of employment. Benefits include: + Medical Benefits + Dental Benefits + Vision Benefits +...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more