- Humana (Hartford, CT)
- … (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- Humana (Hartford, CT)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- CVS Health (Hartford, CT)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals … more
- Humana (Hartford, CT)
- **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Hartford, CT)
- **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...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … more
- Humana (Hartford, CT)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Evolent (Hartford, CT)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... including development of questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into the types of cases… more
- Humana (Hartford, CT)
- …lead Medical Directors performing utilization management for inpatient authorizations training medical director team to assist and facilitate new hires and ... remediation of medical directors performing Medicare utilization management processes...rate with denials and overturns. Deliver the upmost consistent medical director decision making. + _Internal Operations… more
- CVS Health (Hartford, CT)
- …day. **Position Summary** Aetna, a CVS Health company, has an outstanding opportunity for a Medical Director . Ready to take your career to the next level with a ... anywhere in the United States. In this role as Medical Director MPO ( Medical Policy...of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable,… more
- Evolent (Hartford, CT)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Hartford, CT)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Hartford, CT)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management ... recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (Hartford, CT)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a key member of the utilization ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Bayer (Hartford, CT)
- …supporting HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals . Develop ... + In depth understanding of Payer/PBM therapy approval requirements (Prior Authorization, Medical Necessity, Denial Appeals , Formulary coverage and payment for… more
- CVS Health (Hartford, CT)
- …of our members' health care and social determinant needs. The Case Management (CM) Medical Director will participate in executing and deploying our Models of ... member outreach when warranted. * Provides clinical review and adjudication of MCR Appeals case when needed * Professional Development: oversee and manage 1 Regional… more
- Evolent (Hartford, CT)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... care delivery.** + Offer **clinical rationale for standard and expedited appeals ,** ensuring compliance with UM policies and regulatory requirements. + Collaborate… more
- Athena Health Care Systems (Southbridge, MA)
- …+ Mails and tracks all Medicare denial letters. + Retrieves/prints and faxes medical records to QIO for any requested appeals . + Assists with compiling ... (CNA) license and experience is required. + Knowledge of medical terminology, filing, typing, computer, and organizational skills. +...on-going education and provides the information to the RCC/MDS Director so that he/she can follow up. + Enters… more
- Sanofi Group (Hartford, CT)
- …is highly challenging for Health Care Providers (HCPs) and Patients. Payer medical and pharmacy Utilization Management (UM) criteria create process delays for ... patients like required Benefits Investigations (BI), Prior Authorization (PA), Denial Appeals , detailed Clinical Documentation, and Peer to Peer reviews. Assisting… more
- Highmark Health (Hartford, CT)
- …overall efficiencies. + Manage individual projects for timely review with the Director , Clinical Pharmacy. + Participate in Medicare Stars performance measures ... drug benefit strategies, drug formularies, and programs specifically for the Medicare Advantage (MA) market. The incumbent will contribute to recommendations for… more