- CVS Health (Hartford, CT)
- …in the US. **Responsibilities of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part C appeals (both provider ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal...Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- Elevance Health (FL)
- ** Appeals Medical Director - Medicare ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... is granted as required by law. Alternate locations may be considered. The ** Appeals Medical Director ** is responsible for the appeal reviews for physical… more
- Centene Corporation (Jefferson City, MO)
- …with ensuring high quality medical director training to review Medicare UM and appeals , Clinical review quality oversight and management. + Utilization ... improvement activities. + Develop and have oversight of training and expertise for Medicare appeals reviews, ALJ hearings. Have oversight of STARS metrics… more
- Humana (Lincoln, NE)
- …to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the analysis ... of the Medicare rules, Humana policies and medical necessity. The Medical Director ...includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above… more
- Sanford Health (Sioux Falls, SD)
- …oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, including ACA, ... Commercial, Medicare Advantage, Medicaid, DSNP, and ISNP. This role ensures...all state, federal, CMS, HHS, and quality regulations governing appeals and grievance resolution. Lead and manage the end-to-end… more
- Elevance Health (Columbus, OH)
- …recommendations to either uphold or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely ... for medical necessity. + Extrapolates and summarizes medical information for medical director ,...appeals experience. + Leadership or management experience. + Medicare experience. For candidates working in person or virtually… more
- OhioHealth (Columbus, OH)
- …Manager with updates. CGS audits and auditors Working with our legal vendor for Medicare Appeals . Working with OHA and CBSA facilities on wage index ... matter expert in the following areas, S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, Indirect Medical Education, Graduate Medical… more
- Houston Methodist (Katy, TX)
- …medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This ... procedures, and provides quality reviews. Reports results of key performance metrics to director on a timely basis. **FINANCE ESSENTIAL FUNCTIONS** + Assists in the… more
- Humana (Juneau, AK)
- **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
- Humana (Raleigh, NC)
- **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
- Humana (Carson City, NV)
- **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
- CVS Health (Springfield, IL)
- …assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ( Medicare /Medicaid) programs and ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs...individual client requested coverage determinations or appeals when appropriate. - Medical Directors will… more
- Centene Corporation (Baton Rouge, LA)
- …a fresh perspective on workplace flexibility. **We're Hiring: Full-time Behavioral Health Medical Director ** Centene Corporation is a leading provider of ... and Neurology + 5+ years of post-residency experience **Position Purpose:** Assist the Sr Medical Director to direct and coordinate the medical management,… more
- Centene Corporation (Salem, OR)
- …including a fresh perspective on workplace flexibility. **We're Hiring: Full time Medical Director for Trillium Community Health Plan, our Oregon market. ... knowledge of quality accreditation standards highly preferred **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical … more
- CVS Health (Tallahassee, FL)
- …resistant illnesses through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical ... of DSNP/MMP complex populations (Dual-Eligible Special Needs Plan / Medicare -Medicaid Plan) * Develop and lead clinical strategy and...coverage review, member appeals clinical review, medical claim review, and… more
- Evolent (Topeka, KS)
- …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 (Phoenix, AZ)
- …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
- UCLA Health (Los Angeles, CA)
- …Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Medical Director , Clinical Operations to help shape the future of our plan. ... In this key leadership role, you'll work closely with the Medical Director , Department of Health Services and play a vital part in scaling Health Services… more
- CVS Health (Austin, TX)
- …process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject ... CVS Health company, has an outstanding opportunity for a Medical Director . Ready to take your career...of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable,… more
- Evolent (Helena, MT)
- …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
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