- Humana (Boston, MA)
- …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...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Commonwealth Care Alliance (Boston, MA)
- …Exercised:** + None **Essential Duties and Responsibilities:** + Extrapolates and summarizes medical information for medical director , consultants, and other ... to either uphold or deny appeal and forwards to Medical Director as needed. + Ensures that...clinical nursing experience is strongly preferred. + Experience in Medicaid/ Medicare grievances and appeals and/or Utilization Review… more
- Commonwealth Care Alliance (Boston, MA)
- …staff, including nurse reviewers and support personnel. * Act as liaison with medical director , provider relations, case management and quality teams to support ... Management (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care… more