- Humana (Austin, TX)
- **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
- CenterWell (Austin, TX)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Molina Healthcare (Austin, TX)
- …+ Identifies quality-of-care, safety, and compliance concerns and escalate to the Medical Director as appropriate. + Maintains compliance with federal, state, ... criteria (eg, ASAM, MCG, InterQual). + Computer proficiency and experience with electronic medical record or UM systems. To all current Molina employees: If… more
- Molina Healthcare (Austin, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- CVS Health (Austin, TX)
- …a Texas License without encumbrances or willing to obtain a Texas License. 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...and consistent responses to members and providers. As a Medical Director you will focus primarily on… more
- Molina Healthcare (Austin, TX)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- Centene Corporation (Austin, TX)
- …one who changes everything for our 28 million members. **Position Purpose:** Chief Medical Director , Product provides strategic and clinical leadership to the ... related field preferred. 7+ years relevant experience required. Previous experience as Medical Director preferred. Board Certification through American Board of … more
- Humana (Austin, TX)
- …the Regional Vice President of Health Services (RVP) and Health Services Director (HSD). This position focuses on enabling connections with providers, supporting ... for provider partners regarding utilization management operations questions, interfacing with central UM team. + Collaborate with the delegation team to identify and… more