Unfortunately, this job posting is expired.
Don't worry, we can still help! Below, please find related information to help you with your job search.
Don't worry, we can still help! Below, please find related information to help you with your job search.
Related keywords
Some similar recruitments
Medical Records Jobs
Recruited by Sapphire Health Services, LLC 8 months ago
Address Oregon, United States
Medical Records Analyst Jobs
Recruited by Montefiore Medical Center 9 months ago
Address , Tarrytown, 10591
$26.62 an hour
Medical Science Liaison - Florida
Recruited by Teva Pharmaceuticals 9 months ago
Address , Miami, 33101, Fl
Medical Records Analyst Jobs
Recruited by Atlantic Health System 9 months ago
Address , Morristown, 07960, Nj
Hsp Associate Medical Director
Recruited by Amedisys 9 months ago
Address , Media, 19063, Pa
Associate Director- Medical Science Liaison - Dermatology (Southeast Florida)
Recruited by Lilly 9 months ago
Address , Miami, 33125, Fl
Medical Director Jobs
Recruited by Dolce Organic Salon Med Spa & Salt Room 10 months ago
Address Middleburg Heights, OH, United States
Medical Records Expeditor Sr.
Recruited by QTC Management, Inc. 11 months ago
Address , Nashville, 37214, Tn
$17.41 - $18.50 an hour
Medical Records/Scheduler Jobs
Recruited by The Pavilion at Piketon for Nursing and Rehabilitation 11 months ago
Address Beavercreek, OH, United States
Medical Records Technician Jobs
Recruited by US Military Treatment Facilities under DHA 1 year ago
Address , Fort Jackson, Sc
$37,696 - $49,009 a year
Medical Records Technician Jobs
Recruited by Rutgers University 1 year ago
Address , Piscataway, Nj
Medical Records Technician Jobs
Recruited by US Military Treatment Facilities under DHA 1 year ago
Address , Fort Bragg, Nc
$43,778 - $56,908 a year
Clinical Outcomes Manager Jobs
Recruited by OhioHealth 1 year ago
Address , Pickerington, Oh
Associate Medical Science Liaison, Vaccines And Immune Therapies
Recruited by AstraZeneca 1 year ago
Address , Jackson, 39201, Ms
Medical Records Coordinator Jobs
Recruited by Teladoc Health 1 year ago
Address , Quincy, Ma
$19 an hour
Medical Records Jobs
Recruited by Prestige Healthcare Management 1 year ago
Address Akron, OH, United States
Medical Science Liaison (Southeast)
Recruited by NS Pharma 1 year ago
Address , Miami, Fl
Medical Records Request Agent
Recruited by The Urology Group 1 year ago
Address Cincinnati, OH, United States
Medical Records/Scheduler Jobs
Recruited by Centerville Health and Rehab 1 year ago
Address Dayton, OH, United States
Medical Dosimetrist Jobs
Recruited by Oregon Health & Science University 1 year ago
Address , Portland, 97239, Or
Medical Dosimetrist Jobs
Recruited by Golden Valley Memorial Healthcare 1 year ago
Address , Clinton, 64735, Mo
Medical Aesthetician Jobs
Recruited by OVME 1 year ago
Address , Edina, Mn
Medical Records Assistant Jobs
Recruited by Allegro Pediatrics 1 year ago
Address , Bellevue, 98004, Wa
Associate Dir/Medical Director
Recruited by Thermo Fisher Scientific 1 year ago
Address , Wilmington, Nc
Associate Medical Director Jobs
Company | CommuniCare Health Services |
Address | Cincinnati, OH, United States |
Employment type | FULL_TIME |
Salary | |
Category | Hospitals and Health Care |
Expires | 2023-07-25 |
Posted at | 10 months ago |
The CommuniCare Family of Companies currently owns/operates more than 85 Nursing and Rehabilitation Centers, Specialty Care Centers and Assisted Living Communities in 7 states. Since 1984, CommuniCare Health Services has provided superior, comprehensive management services for the development and management of adult living communities.
- Support processes relating to performance and audit of vendors or provider organizations delegated for UM.
- Support care innovations across the enterprise
- Health Care Services Management
- Medical Management
- Support strategies and interventions to improve quality outcomes, medical expense trends, and STARS ratings
- Conduct prior authorization and utilization management activities including adverse determinations.
- Collaborate with medical directors and other clinical leaders from across the contracted network including CHS affiliates as on assigned projects .
- Participate in Plan committees such as Medical Policy, Credentialing, Quality Improvement, Peer Review and others as assigned.
- Collaborate with consultant physicians as necessary to review selected authorization requests or appeals of adverse determinations.
- Lead review and submission of clinical practice guidelines, utilization and concurrent review criteria, and other similar guidelines to Medical Policy or applicable committees.
- Participate in data reviews, sharing and initiatives to improve member outcomes
- Grievance and Appeals
- Serve as ambassador to other enterpriseMedical Directors and clinical leaders
- Models of Care
- Plan Pharmacy Operations
- Assure consistent, high quality execution on HIPAA, Privacy, Program Integrity and Fraud, Waste and Abuse protections and activities
- Support the development and implementation of the Models of Care across the health plan, the CHS Family of Companies and network of providers.
- STARS and clinical quality
- Support processes related to pharmacy appeals process including appeals of adverse determinations.
- Physician Recruitment: Medical Directors, Specialty Physician Program Directors, Attending Physicians
- Assure adherence to regulatory requirements regarding Quality Committees including Quality Improvement, Credentialing, Medical Policy, Peer Review, Quality of Care committees and related activities
- Member and provider satisfaction
- Provider network accessibility, availability and qualifications]
- Assure adherence to documentation and requirements as set forth in the Model of Care for each MA SNP plan
- Complete annual Plan compliance training, IRR, and other compliance-related activities.
- Liaison to providers when necessary to solicit participation in the Plan provider network, committees or to address QOC or other issues.
- Attain and enhance physician and hospital relationships to increase referrals
- Participate in various pharmacy related meetings or activities as assigned.
- Regulatory and Compliance
- Growth and Census Support
- Geriatric training and experience preferred but not required.
- Experience in working in post-acute facilities, assisted living facilities, home and community-based service settings preferred.
- Requires a degree in medicine from an accredited school, Board Certification, and is licensed to practice in applicable states in which the Plan operates.
- Requires at least 15 years of Clinical Experience.
- Requires 3 to 5 years prior experience as a CMO or Associate Medical Director preferably for a Medicare, MMP, or Medicaid plan inclusive of dually eligible enrollees.
-
Systems Analyst - Excel, Xml, Sql, Scripting
By CyberCoders At Salt Lake City, UT, United States 8 months ago
-
(Senior) Finance & Shared Services Manager
By Catholics For Choice At Washington, DC, United States 8 months ago
-
Paralegal - Probate Administration
By CyberCoders At Miami, FL, United States 8 months ago
-
Account Executive - Automotive Software
By ECW Search At United States 8 months ago
-
Construction Project Coordinator Jobs
By CyberCoders At River Falls, WI, United States 8 months ago