- Molina Healthcare (Long Beach, CA)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. Facilitates conformance to ... 3+ years relevant experience, including: 2 years previous experience as a Medical Director in a clinical practice. Current clinical knowledge. Experience… more
- Wealthy Group of Companies LLC (Overland Park, KS)
- …mental health conditions. Our Paola facility offerscomprehensive services, including medical detox, inpatient treatment,and an innovative recovery program blending ... nationalexpansion. This role is 100% in office, in Paola Kansas. The Executive Director at our Paola, Kansas facility is the highest-ranking leader in our flagship… more
- Athens Health and Rehabilitation LLC (Huntsville, AL)
- …to the facility Administrator, Director of Nursing, Regional Administrator, Director of Medicare and Rehabilitation and MDS/Clinical Information Consultant. ... the Administrator, Director of Nursing, Regional Administrator, Director of Medicare and Rehabilitation, and MDS/Clinical... Medicare and Rehabilitation in gathering information for Medicare and Medicaid appeals and denials as… more
- CenCal Health (Santa Barbara, CA)
- …Reporting to the Chief Medical Officer, or his/her designee, the Medical Director is responsible for providing clinical oversight for utilization, quality, ... leadership for medical management functions; assists subordinate managers in resolving medical claims review, grievances, appeals , and other medical … more
- MetroPlusHealth (New York, NY)
- …the medical necessity of requested healthcare services Communicates with Medical Director regarding all inpatient cases and outpatient/ambulatory requests ... including, but not limited to, New York State Medicaid Managed Care, Medicare , Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan,… more
- Rochester Regional Health (Newark, NY)
- …4:30PM SUMMARY Participates and supports oversight of office processes of the Medical Management Department to maintain daily operations. Oversees the daily review ... Oversees the review process of third party payors with oversight from the Director of Care Management. Provides daily oversight of the onsite review activities of… more
- 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
- Molina Healthcare (San Antonio, TX)
- …direct oversight, monitoring and training of local plans' provider dispute and appeals units to ensure adherence with Medicare standards and requirements ... for Medicare and Medicaid Services. * Trains grievance and appeals staff, customer/member services department, sales, UM and other departments within Molina… more
- Molina Healthcare (St. Petersburg, FL)
- **Job Summary** Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for ... etc. * Provides direct oversight, monitoring and training of provider disputes and appeals to ensure adherence with Medicare standards and requirements related… 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 ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Elevance Health (Tampa, FL)
- …recommendations to either uphold or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely ... Medicare ** is responsible for investigating and processing and medical necessity appeals requests from members and...for medical necessity. + Extrapolates and summarizes medical information for medical director ,… 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 ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals … more
- Humana (Olympia, WA)
- **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- LA Care Health Plan (Los Angeles, CA)
- …required by clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory timelines by ... Solution Center Appeals and Grievance Specialists for L. A. Care's Medicare Advantage program. This includes the technical aspects of the time sensitive… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Senior CBO Appeals Analyst position requires an in-depth knowledge of healthcare pricing/reimbursement processes and procedures including ... collaboration with the Underpayment Team manager, the Senior CBO Appeals Analyst will work to further the CBO's goals...meetings. 6. Routinely meets with underpayment team manager and director to provide updates on KPI's. 7. Research and… more
- Elevance Health (Costa Mesa, CA)
- ** Medical Director - Medicare and...the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... required by law. **Candidates must live in California.** The ** Medical Director ** will be responsible for utilization...will be responsible for utilization review case management for Medicare and Medicaid in the California market while also… more
- OhioHealth (Columbus, OH)
- …Manager with updates. CGS audits and auditors Working with our legal vendor for Medicare Appeals . Working with OHA and CBSA facilities on wage index ... matter expert in the following areas, S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, Indirect Medical Education, Graduate Medical… 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...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … 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
- Evolent (Jackson, MS)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... including development of questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into the types of cases… more
