- CareFirst (Baltimore, MD)
- …business needs and work activities/deliverables that week. **ESSENTIAL FUNCTIONS:** + Directs the Medical Review and Appeals units and manages multiple ... managed care or health insurance environment with a focus on Clinical Medical Review and Appeals and Grievances. **Preferred Qualifications:** + Applicants… more
- Elevance Health (Hanover, MD)
- **Clinical Operations Medical Director ** **Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management** **$20,000 Sign On Bonus** ... set of clinical domains, including radiology, cardiology and oncology._ The **Clinical Operations Medical Director supporting our Medical Oncology team** is… more
- Humana (Annapolis, MD)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... caring community and help us put health first** The Medical Director relies on medical ...group practice management. + Utilization management experience in a medical management review organization, such as Medicare… more
- Humana (Annapolis, MD)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all...group practice management. + Utilization management experience in a medical management review organization, such as Medicare… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review , care management and quality to determine the ... needs of members. We are looking for an experienced Medical Director in the greater Baltimore /...reviews, concurrent reviews of inpatient and post-acute care, and appeals . + Oversees all activities of utilization review… more
- Evolent Health (Annapolis, MD)
- …per inter-rater reliability process. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall ... within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure...utilization management while working in conjunction with the Senior Medical Director . May assist the Senior … more
- Prime Therapeutics (Annapolis, MD)
- …**Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the ... as needed to discuss cases and problems. + Utilizes medical /clinical review guidelines and parameters to assure...decisions. + On a requested basis, may function as Medical Director for select health plans or… more
- Evolent Health (Annapolis, MD)
- …timeframe of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical /clinical review guidelines and parameters to ... assure consistency in the MD review process to reflect appropriate utilization and compliance with...timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to… more
- Exelon (Baltimore, MD)
- …estate support for Operations and other Business Units as assigned by the Director , Real Estate & Facilities and/or the Manager to whom supervisory authority has ... and sale of property and property rights, property tax assessments and appeals , property management and other real estate related matters. + Assists in… more
- Exelon (Baltimore, MD)
- …energy delivery operations and other Business Units as assigned by the Director , Real Estate & Facilities, and/or the Manager/Supervisor to whom supervisory ... and sale of property and property rights, property tax assessments and appeals , property management and other real estate related matters. + Negotiates contract… more