- Highmark Health (Carson City, NV)
- …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 (Las Vegas, NV)
- …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 (Carson City, NV)
- …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
- HCA Healthcare (Las Vegas, NV)
- …midpoint of the range. **Introduction** Do you have the career opportunities as a Clinical Resource Director you want with your current employer? We have an ... services , HCA Healthcare. **Benefits** Southern Hills Hospital and Medical Center offers a total rewards package that supports...of colleagues. Do you want to work as a(an) Clinical Resource Director where your passion for… more
- HCA Healthcare (Las Vegas, NV)
- …and vision plans, tuition discounts, along with unique benefits, including: + Comprehensive medical coverage that covers many common services at no cost or ... love for you to apply for the _Director of Clinical Education_ position today! Click here to learn more...and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. +… more
- Prime Therapeutics (Carson City, NV)
- …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
- Highmark Health (Carson City, NV)
- …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
- Cognizant (Carson City, NV)
- …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
- Grifols Shared Services North America, Inc (North Las Vegas, NV)
- …(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 (Carson City, NV)
- …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 (Carson City, NV)
- …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 (Carson City, NV)
- …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 (Carson City, NV)
- … 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 (Carson City, NV)
- …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
- Evolent (Carson City, NV)
- …non- clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),… more
- LifePoint Health (Elko, NV)
- * Director of Emergency Services * * * *This role includes a competitive sign-on bonus, director incentive plan and full relocation package!* *Schedule:*this ... 1 AEMT, 1 PA, and 1 physician per 12-hour shift. * * *How you'll contribute* A Director of Emergency Services who excels in this role: * Assess a variety of… more
- Evolent (Carson City, NV)
- …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. ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),… more
- Humana (Carson City, NV)
- …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...medical interpretation and decisions regarding the appropriateness and medical necessity of services provided by other… more
- Parexel (Carson City, NV)
- …Patients First, Quality, Respect, Empowerment & Accountability. **Parexel is looking for a Medical Director with a very strong background in Ophthalmology to ... remo** t **ely in the US or Canada.** The Medical Director is a medical ... aspects of drug development, including all aspects of Medical Monitoring and study design/execution, preferred + Clinical… more
- Cardinal Health (Carson City, NV)
- …development within the market verticals of Access and Patient Support, Clinical Services and Reimbursement Services . The Director will build key customer ... **Together, we can get life-changing therapies to patients who need them-faster.** The Director of Business Development, Patient Hub Services , is responsible for… more