- Humana (Nashville, TN)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and… 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...overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their… more
- Molina Healthcare (Bowling Green, KY)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- 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...overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy ), and reviews for… more
- Molina Healthcare (Bowling Green, KY)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. *… more
- Molina Healthcare (Bowling Green, KY)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... health and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management policies and procedures to improve… more
- BrightSpring Health Services (Nashville, TN)
- Our Company BrightSpring Health Services Overview The Sr. Director is responsible for management of the Revenue Cycle organization and process to ensure the timely ... on all billings for the rehabilitation business unit. The Sr Director 's responsibilities include identifying reimbursement issues, ensuring that claims, denials, and… more
- Merck (Nashville, TN)
- **Job Description** Associate Director , Field Access Management The Associate Director , Field Access Management serves as the leader to a team of subject-matter ... Market Access, Public Affairs, State and Government Affairs, Trade and Specialty Pharmacy Accounts while abiding by all corporate and industry policy and procedures.… more