- The Cigna Group (Bloomfield, CT)
- …and improving the lives of others? Then look no further! As a Medical Director at EviCore, part of Evernorth Health Services , a division of The Cigna Group, ... medical necessity and appropriateness of the requested service or treatment. + Leverage your clinical ...requested service or treatment. + Leverage your clinical expertise to recommend alternative services or… more
- Highmark Health (Hartford, CT)
- …responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using ... Medical Policy criteria sets to evaluate the ... necessity and appropriateness of the requested treatment of service . Depending on the nature of the case, telephonic… more
- Elevance Health (Wallingford, CT)
- …our care management models for our National Account clients. The medical director will be responsible for supporting the clinical vision and implementation ... the health improvement tools offered to clients/ members. The medical director provides clinical expertise...clinical relevance to account reporting regarding use of medical services by members. Involved in identifying… more
- Humana (Hartford, CT)
- …and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... Humana policies, clinical standards, and (in some cases) contracts. The Medical Director provides medical interpretation and decisions about the… more
- The Cigna Group (Bloomfield, CT)
- … delivery models. They will partner with the Client's Clinical team, Pharmacy Director , Medical Director and/or clinical staff to provide a ... to locations that are listed in this posting.** **Job Summary:** The Sr. Clinical Account Executive (CAE) position is an exciting opportunity for a pharmacist who… more
- Actalent (Hartford, CT)
- …a flexible schedule between 8 AM and 8 PM. What You'll Do + Serve as Medical Director , guiding clinical excellence. + Oversee care at our outpatient clinic ... the future of child and adolescent mental health care. We're seeking a clinical leader who thrives in collaborative environments and is passionate about supporting… more
- Eastern Connecticut Health Network (Manchester, CT)
- … Medical Imaging technical and support staff activities in conjunction with the Medical Imaging Director and Clinical Educator. She/he will consistently ... new procedures and equipment purchases. 16. Interacts with the Medical Imaging Director by proactively communicating any...and unusual situations. 18. Works in collaboration with the Medical Imaging Clinical Educator on quality and… more
- Marrakech, Inc. (Woodbridge, CT)
- …family, friends and acquaintances for their individual qualities and contributions. SUMMARY The Director of Clinical Services plays a vital leadership role ... Administration Course, Medical Awareness, OSHA, and other training related to clinical services . + Ensures LOTUS employees have all necessary access to… more
- CVS Health (Hartford, CT)
- …it all with heart, each and every day. **Position Summary:** The Executive Director , Business Operations - Clinical Nursing provides strategic leadership and ... direction for the Coram Infusion and Specialty Services nursing organization. This role oversees clinical and operational functions to ensure consistent,… more
- University of Connecticut (UConn) (Storrs, CT)
- …of Nursing is seeking applications to fill a full-time, 11-month, Assistant/Associate Clinical Professor, Graduate Track Director - Psychiatric Mental Health ... of Graduate Studies, the faculty member will serve as the Graduate Track Director (GTD) of Psychiatric Mental Health Nurse Practitioner (PMHNP) track. In this role,… more
- Prime Therapeutics (Hartford, CT)
- …our passion and drives every decision we make. **Job Posting Title** Sr Director Clinical Strategy and Oncology Specialty Solutions/PharmD required- REMOTE **Job ... Description** The Senior Director Clinical Strategy and Oncology Specialty Solutions...the development of strategic business roadmaps that integrate both medical and pharmacy solutions. This position will provide leadership… more
- Cognizant (Hartford, CT)
- …submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... denials including but not limited to referral, preauthorization, medical necessity, non-covered services , investigational/experimental and billing resulting… more
- Highmark Health (Hartford, CT)
- …anchor, including MAQCs and pharmacists, in collaboration with the partnership director who manages non- clinical workforce activity. + **Relationship Management ... :** **JOB SUMMARY** This role will support the leadership team for Clinical Transformation and executive physicians in leading the day-to-day operational model of… more
- Grifols Shared Services North America, Inc (Hartford, CT)
- …(MSL primary call points include Immunology, Neurology, Hematology/Oncology). The Field Director ensures compliant execution of field medical plans, strategy, ... and develop, produce and market innovative medicines, solutions and services in more than 110 countries and regions. The...solutions for the therapeutic area(s). + Partners with the Medical Directors, National MSL Sr Director , and… more
- Humana (Hartford, CT)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... , requested level of care, and/or requested site of service should be authorized. All work occurs with a...**Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided… more
- Humana (Hartford, CT)
- …an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... clinical documentation, dispute/grievance and appeals processes, and outpatient services and equipment, within their scope. Medical ...a Lead Medical Director . The Medical Director conducts post- service , inpatient… more
- Humana (Hartford, CT)
- …all activities. **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other ... Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert… more
- CenterWell (Hartford, CT)
- … Medical Director for Home-Based Care Programs is a key clinical leadership position responsible for the medical direction, clinical oversight, ... polychronic, and high-risk Medicare patients within a full-risk, value-based framework. The Medical Director collaborates in a dyad partnership with the Strategy… more
- Humana (Hartford, CT)
- …an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... caring community and help us put health first** The Medical Director relies on medical ...medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with… more
- Moses/Weitzman Health System (New Britain, CT)
- …supports, and builds the expertise of our staff and advanced practice trainees. The Medical Director supervises services provided by the agency's medical ... and demonstrates sound clinical judgment in high risk complex situations. The Medical Director also maintains the agency's compliance with national and state… more