- CareFirst (Baltimore, MD)
- …business needs and work activities/deliverables that week. **ESSENTIAL FUNCTIONS:** + Directs the Medical Review and Appeals units and manages multiple ... managed care or health insurance environment with a focus on Clinical Medical Review and Appeals and Grievances. **Preferred Qualifications:** + Applicants… more
- Elevance Health (Hanover, MD)
- **Clinical Operations Medical Director ** **Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management** **$20,000 Sign On Bonus** ... set of clinical domains, including radiology, cardiology and oncology._ The **Clinical Operations Medical Director supporting our Medical Oncology team** is… more
- Humana (Annapolis, MD)
- …how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... caring community and help us put health first** The Medical Director relies on medical ...group practice management. + Utilization management experience in a medical management review organization, such as Medicare… more
- Humana (Annapolis, MD)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... caring community and help us put health first** The Medical Director relies on medical ...group practice management. + Utilization management experience in a medical management review organization, such as Medicare… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review , care management and quality to determine the ... needs of members. We are looking for an experienced Medical Director in the greater Baltimore /...reviews, concurrent reviews of inpatient and post-acute care, and appeals . + Oversees all activities of utilization review… more
- Defenders of Wildlife (Washington, DC)
- DEFENDERS OF WILDLIFE POSITION DESCRIPTION JOB TITLE: Director , Federal Lands Program CLASSIFICATION: Professional 6 SALARY: $110,000 - $121,000 FLSA: Exempt ... NUMBER OF DIRECT REPORTS: 5 LAST REVISED: January 2024 POSITION SUMMARY Director , Federal Lands Program leads Defenders of Wildlife's work to increase wildlife… more
- Robert Half Finance & Accounting (Washington, DC)
- …reputable non-profit organization in Washington, DC looking for a permanent Human Resources Director . The ideal candidate will act as an employee champion and a ... + Serve as the company's spokesperson in meetings with union representatives to review and respond to cases involving claims, grievances, and discipline appeals … more
- NANA Regional Corporation (Washington, DC)
- …in Washington, DC. **Responsibilities** **Job Responsibilities:** + Manages schedules for the Director and the Deputy Director . With broad guidance from the ... Director and Deputy Director , plan, arrange and monitor meetings and appointments. Negotiate...+ Undertake special administrative support projects as needed (ie review and disposition of Office's physical and electronic files).… more
- GAP Solutions Inc (Rockville, MD)
- …Counsel in reviewing and arriving at recommendations regarding requests involving administrative appeals . + Review appeals for non-release of information ... of the overall functions of the Office of the Director (OD), Office of Science Management and Operations (OSMO)...for information, determine the appropriateness of the release and review and make recommendations regarding appeals . +… more
- Highmark Health (Annapolis, MD)
- …process, and consult with the Organization's Associate Medical Directors and Medical Directors when appropriate, follow-up on appeals in accordance with our ... utilization management programs, and case/ disease management initiatives; providing clinical review and decisions for physician and member appeals and… more
- Evolent Health (Annapolis, MD)
- …timeframe of the request. + Provides clinical rationale for standard and expedited appeals . + Utilizes medical /clinical review guidelines and parameters to ... assure consistency in the MD review process to reflect appropriate utilization and compliance with...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… more
- Prime Therapeutics (Annapolis, MD)
- …**Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the ... as needed to discuss cases and problems. + Utilizes medical /clinical review guidelines and parameters to assure...decisions. + On a requested basis, may function as Medical Director for select health plans or… more
- Evolent Health (Annapolis, MD)
- …timeframe of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical /clinical review guidelines and parameters to ... assure consistency in the MD review process to reflect appropriate utilization and compliance with...timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to… more