- Humana (Topeka, KS)
- **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...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Elevance Health (Overland Park, KS)
- …nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy ... care, eg, if services are not in line with diagnosis. + Provide consultation to Medical Director on particularly peculiar or complex cases as the nurse deems… more
- CVS Health (Topeka, KS)
- … medical license without encumbrances in one of these states.** + In the Medical Director role you will provide oversight for medical policy ... Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...consistent responses to members and providers. + As a Medical Director you will focus primarily on… more
- Blue KC (KS)
- …financial assistance** **Employee discount program** **Job Description Summary:** The Lead Medical Director actively uses their clinical training, experience, ... level of care, and/or requested site of service should be authorized. The Medical Director will apply various clinical policies, state and federal guidance,… more
- Blue KC (KS)
- …UM system in accord with UM concurrent review guidelines. Consults with Medical Director on cases outside medical policy, notifies providers and ... of our offerings include:** **Highly competitive total rewards package, including comprehensive medical , dental and vision benefits as well as a 401(k) plan that… more
- Evolent (Topeka, KS)
- …Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, ... that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers.... + Appropriately identifies and refers quality issues to UM Leadership. + Appropriately identifies potential cases for Care… more