- Sanford Health (Sioux Falls, SD)
- …or regulatory review functions. Strong knowledge of CMS, Medicaid, ACA, and Commercial appeals and grievances regulations. **Benefits** Sanford Health offers an ... oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, including ACA,… more
- Humana (Topeka, KS)
- … (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 (Olympia, WA)
- …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
- Beth Israel Lahey Health (Charlestown, MA)
- …plays an important role in a high-profile team tasked with handling all commercial and government clinical appeals and audit processes. The Clinical Analyst ... gather information that would support submitted charges. Prepare clinical appeals relevant to the audits in order to prove... relevant to the audits in order to prove medical necessity and level of care were warranted in… more
- CVS Health (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
- CVS Health (IL)
- …portion of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ... **Position Summary** CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director ( Medical Affairs). This is a remote based, work… more
- Humana (Montgomery, AL)
- **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 (Washington, DC)
- **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 (San Juan, PR)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Humana (Raleigh, NC)
- **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
- Blue KC (MO)
- …financial assistance** **Employee discount program** **Job Description Summary:** The Lead Medical Director actively uses their clinical training, experience, ... and/or requested site of service should be authorized. The Medical Director will apply various clinical policies,...medical , surgical and pharmacy activity. + Participates in medical appeals activity. Reviews all appealed cases… more
- Elevance Health (Walnut Creek, CA)
- **Behavioral Health Medical Director - Child Psychiatrist** Location: This role enables associates to work virtually full-time, with the exception of required ... be considered. Schedule: Fulltime position, Monday through Friday. The **Behavioral Health Medical Director - Child Psychiatrist** is responsible for completing … more
- Blue KC (KS)
- …management for medical , surgical and pharmacy activity. + Participates in medical appeals activity. Reviews all 2nd-level overturned cases related to ... potential medical policy updates. + Serves as expert/resource on appeals related to utilization management issues. + The following Essential Accountabilities are… more
- Sumitomo Pharma (Raleigh, NC)
- …seeking a highly motivated and experienced individual for the position of ** Director , Patient Services** . Primary responsibilities include leading and developing a ... strategic framework for patient support services, aligned with brand imperatives. The Director has oversight of patient services operations and manages within the… 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
- State of Colorado (Garfield County, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... in public safety. Full benefits are provided. Apprentices will earn their Commercial Driver's License and the requirements to qualify for a Highway Maintenance… more
- State of Colorado (CO)
- …of notice or knowledge of the action: Colorado State Personnel Board/State Personnel Director , Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver, ... development opportunities and a wide range of benefits. + Medical and dental options are available for permanent employees...with industry to support safe transport of materials on commercial motor carriers in Colorado. + Aircraft Program -… more
- State of Colorado (Park County, CO)
- …Colorado Code of Regulations (CCR) 801-1,State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and ... public? Do you have a Class A or B Commercial Driver's License? If so, come join CDOT as...keeping them safe. The State of Colorado offers competitive medical , dental and vision insurance, life and disability insurance,… more
- City and County of San Francisco (San Francisco, CA)
- …service examination process is subject to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or the Civil Service ... or university in horticulture, landscaping, gardening, nursery and garden center operation, commercial cut flower and greenhouse production or related field and two… more