- CVS Health (CT)
- …urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and prior ... services to its membership. Aetna is looking for a medical director to be part of a...state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another… more
- Evolent (Hartford, CT)
- …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management … more
- Humana (Hartford, CT)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Hartford, CT)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… more
- Humana (Hartford, CT)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Cognizant (Hartford, CT)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years'… more
- Elevance Health (Wallingford, CT)
- …responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for both ... Director ** is responsible for serving as the Operational Medical Director for our care management...director provides clinical expertise in all aspects of utilization review and case management . Provides input… more
- Evolent (Hartford, CT)
- …for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director in ... , you will be a key member of the utilization management team. We can offer you...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Evolent (Hartford, CT)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Evolent (Hartford, CT)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Humana (Hartford, CT)
- …health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management ... caring community and help us put health first** The Medical Director actively uses their medical...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Hartford, CT)
- …in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a...Oncology, you will be a key member of the utilization management team. We can offer you… more
- Evolent (Hartford, CT)
- …in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be...Surgery you will be a key member of the utilization management team. We can offer you… more
- Evolent (Hartford, CT)
- …in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , Physical Medicine and Rehab you...Rehab you will be a key member of the utilization management team. We can offer you… more
- Elevance Health (Wallingford, CT)
- **Behavioral Health Medical Director -Psychiatrist Appeals** **Location:** This role enables associates to work virtually full-time, with the exception of ... Friday. Half day Saturday rotation, once a month.** The **Behavioral Health Medical Director -Psychiatrist Appeals** is responsible for the administration of… more
- Hartford HealthCare (Norwich, CT)
- …** Management / Administration* **Organization:** **Backus Hospital* **Title:** *Regional Director of Medical Staff Services, East Region* **Location:** ... become part of Connecticut's most comprehensive healthcare network. Position Summary: The Regional Director of Medical Staff Services leads the Medical Staff… more
- Humana (Hartford, CT)
- …organization focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with ... 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… more
- Sedgwick (Hartford, CT)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Sr. VP Medical Director **PRIMARY PURPOSE** **:** To evaluate medical reports ... and assure efficient, cost effective, quality program delivery for medical and disability management . + Coordinating and...required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality… more
- CVS Health (CT)
- …a remote based (work at home) based anywhere in the US. **Responsibilities of this Medical Director role are related to Medicare Appeals:** * Direct daily work ... 24/7 appeals work * IRE monitoring and tracking and Utilization Management Strategy support * Develop subject...in ABMS or AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance &… more
- CVS Health (CT)
- …anywhere in the US.** Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home. The ... Medical Director (Spine) will be a Subject...responses to members and providers. Leads all aspects of utilization review/quality assurance, directing case management Provides… more