- Highmark Health (Honolulu, HI)
- …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 ... necessity and appropriateness of the requested treatment of service . Depending on the nature of the case, telephonic… more
- Humana (Honolulu, HI)
- …and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... Humana policies, clinical standards, and (in some cases) contracts. The Medical Director provides medical interpretation and decisions about the… more
- Cognizant (Honolulu, HI)
- …submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... denials including but not limited to referral, preauthorization, medical necessity, non-covered services , investigational/experimental and billing resulting… more
- Highmark Health (Honolulu, HI)
- …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
- Humana (Honolulu, HI)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... , requested level of care, and/or requested site of service should be authorized. All work occurs with a...**Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided… more
- Humana (Honolulu, HI)
- …an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... clinical documentation, dispute/grievance and appeals processes, and outpatient services and equipment, within their scope. Medical ...a Lead Medical Director . The Medical Director conducts post- service , inpatient… more
- Humana (Honolulu, HI)
- …all activities. **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other ... Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert… more
- Always Best Care Senior Services (Honolulu, HI)
- … Director of Nursing (DON) Designee / Director of Patient Care Services Designee to lead our clinical team with heart, integrity, and aloha. Job ... Description: The DON Designee / Director of Patient Care Services (DPCS) Designee...Services (DPCS) Designee is responsible for the overall clinical direction and coordination of home health services… more
- CenterWell (Honolulu, HI)
- … 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 (Honolulu, HI)
- …an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... caring community and help us put health first** The Medical Director relies on medical ...medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with… more
- Evolent (Honolulu, HI)
- …non- clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),… more
- Evolent (Honolulu, HI)
- …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. ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),… more
- Genesis Healthcare (Honolulu, HI)
- … Clinical Director . 18. Promotes all Powerback Rehabilitation products and services whenever possible. 19. Assists Clinical Operations Area Director ... Provides direct patient care. 3. Monitors the standard of clinical services being delivered and maintained in...of clinical requirements, and recommendations from the Clinical Director . 12. Administers financial controls of… more
- Humana (Honolulu, HI)
- …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...medical interpretation and decisions regarding the appropriateness and medical necessity of services provided by other… more
- Parexel (Honolulu, HI)
- …Patients First, Quality, Respect, Empowerment & Accountability. **Parexel is looking for a Medical Director with a very strong background in Ophthalmology to ... remo** t **ely in the US or Canada.** The Medical Director is a medical ... aspects of drug development, including all aspects of Medical Monitoring and study design/execution, preferred + Clinical… more
- Cardinal Health (Honolulu, HI)
- …development within the market verticals of Access and Patient Support, Clinical Services and Reimbursement Services . The Director will build key customer ... **Together, we can get life-changing therapies to patients who need them-faster.** The Director of Business Development, Patient Hub Services , is responsible for… more
- Evolent (Honolulu, HI)
- …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 ... timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to...Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),… more
- Evolent (Honolulu, HI)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a key member of the utilization ... timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to...Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),… more
- Humana (Honolulu, HI)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with… more
- Hawaii Pacific Health (Lihue, HI)
- … for the hospitals and serve the facility with customer service , clinical competency and fiscal responsibility. As Director , you will provide strategic ... Founded in 1938, Wilcox Medical Center is a not-for-profit medical ...and is responsible for assigned areas within our flagship Clinical Service Line operations. These areas may… more