- Humana (Carson City, NV)
- … (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- Humana (Little Rock, AR)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code… more
- Elevance Health (Dearborn, MI)
- ** Medical Director - Commercial ** Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... able to work East Coast time zone hours.** The ** Medical Director ** will be responsible for utilization...will be responsible for utilization review case management for Commercial business in the New England (CT, ME, and… more
- CVS Health (Austin, TX)
- …You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address ... member needs across the continuum of care. + You will support the Medical Management staff ensuring timely and consistent responses to members and providers. + This… more
- Humana (Providence, RI)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- Humana (Salem, OR)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- Humana (Charleston, WV)
- **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
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... care and for all of Sharp Health Plan products, ( Commercial , Exchange, Medicare, POS/PPO) services, and oversees the health...+ 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons… more
- Humana (Bismarck, ND)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- CVS Health (Hartford, CT)
- …day. **Position Summary** Aetna, a CVS Health company, has an outstanding opportunity for a Medical Director . Ready to take your career to the next level with a ... anywhere in the United States. In this role as Medical Director MPO ( Medical Policy...of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable,… more
- AdventHealth (Altamonte Springs, FL)
- …drafting and submitting clinical denial appeals , as needed + Develops Medical Director relationships with payors to have open communication and consistently ... as a liaison between UM and CM teams and medical staff, as well as, the medical ...Officers and acts as a liaison between contracted Managed Care/ Commercial payors related to managed care denials, Care Management… more
- Elevance Health (Los Angeles, CA)
- **Behavioral Health Medical Director - Child Psychiatrist** Location: This role enables associates to work virtually full-time, with the exception of required ... Fulltime position, Monday through Friday. Open to part-time. The **Behavioral Health Medical Director - Child Psychiatrist** is responsible for completing … more
- State of Colorado (Denver, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... Division Director - Management Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5014697) Apply Division Director - Management Salary… more
- Bayer (Boston, MA)
- …supporting HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals . Develop ... + In depth understanding of Payer/PBM therapy approval requirements (Prior Authorization, Medical Necessity, Denial Appeals , Formulary coverage and payment for… more
- Banner Health (Phoenix, AZ)
- …Clinical Decision Making **Work Shift:** Day **Job Category:** Physicians The Senior Medical Director , Network Performance is a senior clinical executive ... leadership, enterprise collaboration, and credible clinical engagement, the Senior Medical Director will ensure Banner's network strategy consistently… more
- Takeda Pharmaceuticals (Boston, MA)
- …purpose and be empowered to deliver your best. Join Takeda as the Associate Director , Patient Services Operations out of our Cambridge, MA office. As the Associate ... Director , Patient Services Operations, you will lead the design,...Sales Leadership, Marketing, Contracts and Pricing, Legal, Compliance, Training, Medical and Scientific Affairs and Regulatory, along with relevant… more
- Marathon Petroleum Corporation (Salt Lake City, UT)
- …our people, and fosters a collaborative team environment. Overview: The Supply Chain Director is responsible for all ongoing Supply Chain activities within the Salt ... ensures that the refinery takes full but fair advantage of its commercial position when procuring services, materials, and equipment, managing risk, maintaining… more
- CVS Health (Scottsdale, AZ)
- …And we do it all with heart, each and every day. As the Lead Director of Market Conduct Exams for the Network Services area, you will have the opportunity ... pertaining to PBM network comprehensive activities. In this role the Lead Director will be responsible for developing our internal (Government Affairs) and external… more
- Somatus (Mclean, VA)
- …the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Flexible Paid Time Off (PTO) + Professional ... well-being + Community engagement opportunities + And more! The Director of Quality, reporting to the AVP of Quality,...guidance and oversight to all lines of business including Commercial , Medicaid, Medicare, and Special Need Plans (SNPs). The… more