- Elevance Health (Columbus, OH)
- ** Clinical Compliance Medical Director ** _Please note that per our policy t_ _his role enables associates to work virtually full-time, with the exception ... for employment, unless an accommodation is granted as required by law._ The ** Clinical Compliance Medical Director ** is responsible for providing … more
- Sumitomo Pharma (Columbus, OH)
- …a dynamic, highly motivated, and experienced individual for the position of Senior Medical Director , Clinical Research (Ophthalmology) to join our R&D ... systems and final reports in compliance with appropriate scientific/regulatory/ medical standards + Contributes to developing clinical components of… more
- Highmark Health (Columbus, OH)
- …responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using ... Medical Policy criteria sets to evaluate the ...to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations… more
- OhioHealth (Columbus, OH)
- …- in our careers and in our communities. **Job Description Summary:** The Clinical Enterprise Director will have operational and strategic responsibilities for a ... teams to drive successful efforts to support service line, medical group, and care site goals on delivering on...and staff culture. This role reports to a Sr Director or Vice President, Clinical Enterprise. **Responsibilities… more
- Highmark Health (Columbus, OH)
- …anchor, including MAQCs and pharmacists, in collaboration with the partnership director who manages non- clinical workforce activity. + **Relationship Management ... :** **JOB SUMMARY** This role will support the leadership team for Clinical Transformation and executive physicians in leading the day-to-day operational model of… more
- Prime Therapeutics (Columbus, OH)
- …our passion and drives every decision we make. **Job Posting Title** Sr Director Clinical Strategy and Oncology Specialty Solutions/PharmD required- REMOTE **Job ... Description** The Senior Director Clinical Strategy and Oncology Specialty Solutions...the development of strategic business roadmaps that integrate both medical and pharmacy solutions. This position will provide leadership… more
- Humana (Columbus, OH)
- **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...authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which… more
- Humana (Columbus, OH)
- …Humana policies, clinical standards, and (in some cases) contracts. The Medical Director provides medical interpretation and decisions about the ... and experience with national guidelines such as NCD/LCD, MCG(R) or InterQual The Medical Director conducts clinical case reviews of requests received… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... level. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which...to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of… more
- Humana (Columbus, OH)
- … Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert ... caring community and help us put health first** The Medical Director actively uses their medical...discussions with external providers by phone to gather additional clinical information and discuss determinations. Medical directors… more
- CenterWell (Columbus, OH)
- … Medical Director for Home-Based Care Programs is a key clinical leadership position responsible for the medical direction, clinical oversight, ... polychronic, and high-risk Medicare patients within a full-risk, value-based framework. The Medical Director collaborates in a dyad partnership with the Strategy… more
- Humana (Columbus, OH)
- **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...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins… more
- Evolent (Columbus, OH)
- …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
- Merck (Columbus, OH)
- **Job Description** **Role Summary** The US Director Medical Affairs (USDMA) is a regionally based position within our Company Research Laboratories, US ... company medicines. + Partner with GSVC, CSEE, US Global Clinical Trial Organization (GCTO), Global Medical and...including Health Systems. + Collaborate with the USMA Field Medical Alignment Director (FMAD) to ensure consistent… more
- Elevance Health (Columbus, OH)
- …required by law. Alternate locations may be considered. The **Manager, Medical Director ** will serve as a clinical and strategic advisor to enterprise ... **Manager, Medical Director - Transformation Initiatives** Location:...expectations. **Regulatory & Compliance Oversight** + Ensure compliance with clinical , accreditation, and regulatory standards… more
- Grifols Shared Services North America, Inc (Whitehall, OH)
- …(MSL primary call points include Immunology, Neurology, Hematology/Oncology). The Field Director ensures compliant execution of field medical plans, strategy, ... team of MSLs throughout the entire US. + Maintains clinical knowledge of designated therapeutic area(s) and broad market...solutions for the therapeutic area(s). + Partners with the Medical Directors, National MSL Sr Director , and… more
- Evolent (Columbus, OH)
- …per inter-rater reliability process. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall ... within the regulatory timeframe of the request. + Utilizes medical / clinical review guidelines and parameters to assure...utilization management while working in conjunction with the Senior Medical Director . May assist the Senior … more
- Evolent (Columbus, OH)
- …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 (Columbus, OH)
- …mission. Stay for the culture. **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Humana (Columbus, OH)
- …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...necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD… more