- Merck & Co. (North Wales, PA)
- …to results-oriented project management skillsPreferred: At least 3 years regional medical affairs experience (eg, Regional Director Medical Affairs) with ... Job Description Role Summary: The Global Senior Director Medical Affairs (GDMA) is a...review process. Manages programs (patient support, educational or risk management ) to support appropriate and safe utilization … more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview:** The Medical Director , Utilization Management , provides organizational leadership in the operational areas of appeals, utilization ... and related policy and practice initiatives in collaboration with the Corporate Medical Directors, Utilization Management and the Vice President, Medical … more
- Humana (Trenton, NJ)
- … Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care received ... caring community and help us put health first** The Medical Director actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Trenton, NJ)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Trenton, NJ)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… more
- Humana (Trenton, NJ)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- CVS Health (Trenton, NJ)
- …plans in Aetna's Northeast region but may support other plans when needed. This UM ( Utilization Management ) Medical Director will be a "Work from ... and every day. **Position Summary:** Ready to take your Medical Director skills to the next level...and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well… more
- Cognizant (Trenton, NJ)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years'… more
- Evolent (Trenton, NJ)
- …for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director in ... , you will be a key member of the utilization management team. We can offer you...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- UPMC (Media, PA)
- …committees of the PH MCOs. + Reviews the medical aspects of cost and utilization reports generated by Medical Management Information System. + Acts as a ... a qualified individual to fulfill the role of Regional Medical Director in Delaware County, PA. The...Community Care members. This includes significant responsibility for quality management and utilization management and… more
- Evolent (Trenton, NJ)
- …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management … more
- Evolent (Trenton, NJ)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Evolent (Trenton, NJ)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Humana (Trenton, NJ)
- …health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management ... caring community and help us put health first** The Medical Director actively uses their medical...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Trenton, NJ)
- …in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a...Oncology, you will be a key member of the utilization management team. We can offer you… more
- Highmark Health (Trenton, NJ)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community… more
- Evolent (Trenton, NJ)
- …in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... Radiology you will be a key member of the utilization management team. We can offer you...Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Merck (North Wales, PA)
- **Job Description** **Role Summary:** The Global Senior Director Medical Affairs (GDMA) is a subject matter expert in their area of responsibility (eg, defined ... and tactical execution. Communicates pertinent information to stakeholders (eg, Executive Director Medical Affairs (EDMA), Regional Strategy Leads (RSL),… more
- Humana (Trenton, NJ)
- …organization focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with ... part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and… more
- Sedgwick (Trenton, NJ)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Sr. VP Medical Director **PRIMARY PURPOSE** **:** To evaluate medical reports ... and assure efficient, cost effective, quality program delivery for medical and disability management . + Coordinating and...required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality… more
