- Highmark Health (Topeka, KS)
- …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
- Elevance Health (Overland Park, KS)
- …our care management models for our National Account clients. The medical director will be responsible for supporting the clinical vision and implementation ... the health improvement tools offered to clients/ members. The medical director provides clinical expertise...clinical relevance to account reporting regarding use of medical services by members. Involved in identifying… more
- Humana (Topeka, KS)
- …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
- CVS Health (Topeka, KS)
- …Level Appeals / Special Projects and Committee participation when needed. + The Medical Director will provide clinical , coding, and reimbursement expertise ... participation in clinical team activities. + The Medical Director will act as lead business...providers and facilities to support the effective execution of medical services programs by the clinical… more
- HCA Healthcare (Wichita, KS)
- …and initializing timely, appropriate patient transfers. In collaboration with the Rehab Medical Director , the Clinical Rehabilitation Specialist ensures ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services ...and off-site clinical evaluations to assist Rehab Medical Director in determining patient eligibility for… more
- Blue KC (KS)
- …level of care, and/or requested site of service should be authorized. The Medical Director will apply various clinical policies, state and federal ... adoption financial assistance** **Employee discount program** **Job Description Summary:** The Lead Medical Director actively uses their clinical training,… more
- Genesis Healthcare (Lenexa, KS)
- …Operations Area Director , and the Clinical Director . 15. Assists Director of Rehab with customer service . 16. Ensures that the clinical ... Assists in the efficient and profitable management of rehabilitation services in sites of service and home...of clinical requirements and recommendations from the Clinical Director . 8. Continues direct patient care.… more
- Prime Therapeutics (Topeka, KS)
- …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
- Highmark Health (Topeka, KS)
- …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
- Cognizant (Topeka, KS)
- …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
- AdventHealth (Shawnee, KS)
- ** Director Clinical Documentation Integrity - AdventHealth...dedicated teams and staff, and a wide variety of medical services , all at our hospital in ... you need for you and your family:** - Vision, Medical & Dental Benefits from Day One - Student...Shawnee Mission, Kansas. **The role you'll contribute:** The Director of Clinical Documentation Integrity (CDI) is… more
- Grifols Shared Services North America, Inc (Kansas City, KS)
- …(MSL primary call points include Immunology, Neurology, Hematology/Oncology). The Field Director ensures compliant execution of field medical plans, strategy, ... and develop, produce and market innovative medicines, solutions and services in more than 110 countries and regions. The...solutions for the therapeutic area(s). + Partners with the Medical Directors, National MSL Sr Director , and… more
- Humana (Topeka, KS)
- …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 (Topeka, KS)
- …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 (Topeka, KS)
- …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
- CenterWell (Topeka, KS)
- … 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 (Topeka, KS)
- …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
- HCA Healthcare (Overland Park, KS)
- …through administrative and clinical staff including providers, front desk, medical records, nursing, and ancillary services to ensure maximum utilization ... invested over 156,000 hours impacting our communities. As a Director of Physician Services I with Overland...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services … more
- Evolent (Topeka, KS)
- …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
- Elevance Health (Overland Park, KS)
- ** Medical Director -Cardiology Appeals** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law. The ** Medical Director -Cardiology Appeals** is responsible for the...responsible for the review of appeals for physical health medical services , to ensure the appropriate and… more