- Humana (Nashville, TN)
- **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...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- CenterWell (Nashville, TN)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- CVS Health (Nashville, TN)
- … medical license without encumbrances in one of these states.** + In the Medical Director role you will provide oversight for medical policy ... Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...consistent responses to members and providers. + As a Medical Director you will focus primarily on… more
- Evolent (Nashville, TN)
- …Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, ... that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers.... + Appropriately identifies and refers quality issues to UM Leadership. + Appropriately identifies potential cases for Care… more
- YesCare Corp (Brentwood, TN)
- …and maintain pre-established review parameters under the direction of the YesCare Medical Director . + Identify and document comparisons with community standards, ... specific time frame to ensure resources are maximized. + Work with other UM inpatient and outpatient nurse reviewers to assure proper treatment in the appropriate… more
- Humana (Nashville, TN)
- …the Regional Vice President of Health Services (RVP) and Health Services Director (HSD). This position focuses on enabling connections with providers, supporting ... for provider partners regarding utilization management operations questions, interfacing with central UM team. + Collaborate with the delegation team to identify and… more