- Humana (Springfield, IL)
- …scenarios arise from outpatient , inpatient or post-acute care environments. The Medical Director will have discussions with external physicians by phone to ... caring community and help us put health first** The Medical Director relies on medical ...work is assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations,… more
- CenterWell (Springfield, IL)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... caring community and help us put health first** The Medical Director , Primary Care relies on ...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Humana (Springfield, IL)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... caring community and help us put health first** The Medical Director relies on medical ...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Humana (Springfield, IL)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... caring community and help us put health first** The Medical Director actively uses their medical...work is assisted by diverse resources, which may include national clinical guidelines, CMS and state policies and determinations,… more
- CVS Health (Springfield, IL)
- …do it all with heart, each and every day. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout ... Better Health Plan of Illinois. This UM (Utilization Management) Medical Director will be a "Work from...as concurrent review. Cases could focus on inpatient or outpatient services, acute and post acute services, pharmacy, appeals… more
- Cardinal Health (Springfield, IL)
- …of documentation and coding related to physician or hospital (inpatient and outpatient ) billing and/or medical necessity reviews. + Prepares written reports ... and compliance issues. **Compliance Audit Manager** Reporting to the Compliance Director , this position supervises and manages compliance audits to determine… more
- Cognizant (Springfield, IL)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued member… more
- Datavant (Springfield, IL)
- …and existing coders. **You Will:** + Conduct inpatient coding audits on medical records, utilizing ICD-10-CM, CPT, and appropriate coding references for accurate DRG ... results for review by the facility or CCS HIM director . + Review disagreements on APC/DRG changes with the...trauma centers + Experience coding and auditing inpatient and outpatient records for various facilities + Track record of… more