- Humana (Indianapolis, IN)
- …a 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 preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Humana (Indianapolis, IN)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Elevance Health (Indianapolis, IN)
- …records of denied services for medical necessity. + Extrapolates and summarizes medical information for medical director , consultants and other external ... or overturn (approve) requested appealed service and forwards to Medical Director for final review and decision....final review and decision. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. +… more
- Cognizant (Indianapolis, IN)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a... Medicare , Medicaid, and third-party guidelines. . Effectively document and… more