- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... or their respective auditors JOB DUTIES AND RESPONSIBILITIES: Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code… more
- American Recruiting and Consulting Group (Jacksonville, FL)
- …department) as a committee chairperson or other leadership * Medical Director experience in Medicare-related or commercial healthcare organization * Coding ... MEDICAL DIRECTOR - REMOTE ARC Group... MEDICAL DIRECTOR - REMOTE ARC Group has an immediate...program. * Provide clinical consultation to internal teams (eg, medical review staff, appeals teams) and external… more
- NewGen Administrative Services (Montebello, CA)
- …throughout the company Participates in annual AR strategic planning under direction of the Director of AR Assists in planning annual AR event for BOMs Meets with ... Director of AR on a monthly basis to discuss...eligibility for all payor types, such as Medicaid, Medicare, commercial , etc Teaches authorization process for all payors Teaches… more
- The University Corporation (Los Angeles, CA)
- …The University Corporation is a nonprofit corporation, providing business, commercial , real estate, financial and administrative services to California State ... secure. Regularly communicate and update the Coordinator and the Director of the Bookstein Institute on matters affecting the...USTC appearance. Discusses US Tax Cases with Office of Appeals in an attempt to settle cases out of… more
- Memorial Health (Marysville, OH)
- …Functions: Ensures insurance claims are sent timely and accurately to government, commercial and managed care plans, adhering to payer timely filing requirements. ... receivables at or above departmental established goals. Prepares and submits appeals , collecting all pertinent documentation; filing per each individual payer's… more
- CVS Health (Santa Fe, NM)
- …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 (Carson City, NV)
- … (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 (Little Rock, AR)
- …Director relies on medical background and reviews 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 about the… more
- Elevance Health (Dearborn, MI)
- ** Medical Director - Commercial ** Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... able to work East Coast time zone hours.** The ** Medical Director ** will be responsible for utilization...will be responsible for utilization review case management for Commercial business in the New England (CT, ME, and… more
- CVS Health (Austin, TX)
- …You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address ... member needs across the continuum of care. + You will support the Medical Management staff ensuring timely and consistent responses to members and providers. + This… more
- Humana (Salem, OR)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- Humana (Montpelier, VT)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- Humana (Charleston, WV)
- **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
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... care and for all of Sharp Health Plan products, ( Commercial , Exchange, Medicare, POS/PPO) services, and oversees the health...+ 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons… more
- Humana (Bismarck, ND)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… 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
- Elevance Health (Los Angeles, CA)
- **Behavioral Health Medical Director - Child Psychiatrist** Location: This role enables associates to work virtually full-time, with the exception of required ... Fulltime position, Monday through Friday. Open to part-time. The **Behavioral Health Medical Director - Child Psychiatrist** is responsible for completing … more
- State of Colorado (Denver, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... Division Director - Management Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5014697) Apply Division Director - Management Salary… more
- Bayer (Boston, MA)
- …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
- Banner Health (Phoenix, AZ)
- …Clinical Decision Making **Work Shift:** Day **Job Category:** Physicians The Senior Medical Director , Network Performance is a senior clinical executive ... leadership, enterprise collaboration, and credible clinical engagement, the Senior Medical Director will ensure Banner's network strategy consistently… more
