- Highmark Health (St. Paul, MN)
- …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 (St. Paul, MN)
- …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
- The Cigna Group (Bloomington, MN)
- … delivery models. They will partner with the Client's Clinical team, Pharmacy Director , Medical Director and/or clinical staff to provide a ... to locations that are listed in this posting.** **Job Summary:** The Sr. Clinical Account Executive (CAE) position is an exciting opportunity for a pharmacist who… more
- The Cigna Group (Bloomington, MN)
- …delivery models. They will partner with the Health Plan's Pharmacy Director , Medical Director and clinical staff to provide a comprehensive management ... to locations that are identified in this posting.** **JOB DESCRIPTION** The Clinical Account Executive (CAE) position is an exciting opportunity for a pharmacist… more
- Fairview Health Services (Brooklyn Park, MN)
- …and collaborate regularly with the Clinic Leadership Team (eg Medical Director , Operations Director , Clinic Manager, Clinical Supervisor). + Performs ... promote a team environment. Respond first to COMPASS events, reporting outcome to medical director . Ensures completion of annual provider requirements (eg LMS… more
- Presbyterian Homes and Services (Arden Hills, MN)
- Overview Presbyterian Homes & Services - Johanna Shores is seeking a Director of Nursing / Clinical Administrator to join our Long Term Care team leading the ... the care setting) and directly supervises all managers of clinical services which may include: Clinical...Care, Long Term Care with Memory Care Responsibilities The Director of Nursing / Clinical Administrator is… more
- Fairview Health Services (Maple Grove, MN)
- …**Practice Description** **Fairview Health Services ** seeks a Site Medical Director - Women's and Children's Service Line for its **M Health Fairview ... and Surgery Center - Maple Grove** . The Site Medical Director , Women and Children's Service... Line - Women's in dyadic partnership with the Director Women's Services leads Women's care teams… more
- Prime Therapeutics (St. Paul, MN)
- …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 (St. Paul, MN)
- …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
- Fairview Health Services (St. Paul, MN)
- …Overview** **Fairview Health Services ** is seeking a full-time Nurse Practitioner ** Medical Director ** , **Acute and Diagnostic Services ,** to provide ... care, quality outcomes, provider engagement, and financial performance. The Medical Director serves as a leader, mentor,...+ 1 FTE (0.4 FTE Admin and 0.6 FTE clinical ) + Provide leadership and oversight to physicians and… more
- Fairview Health Services (Edina, MN)
- **Job Overview** **Fairview Health Services ** seeks a Site Medical Director - Women's and Children's Service Line for its M Health Fairview Center for ... targets including operating, financial, productivity; annual quality plan and clinical outcomes metrics; practice standards; annual customer experience plan;… more
- Wellpath (Buffalo, MN)
- …They ensure necessary documentation of services is provided to the Site Medical Director ordesigneetomonitorthe provision of clinical services . ... benefits varies based on employee type and length of service . **Why Us** **Now is your moment to make... Director andH.S.A. andmake arrangementsfor coverage of medical services if unavailable for an extendedperiod… more
- Grifols Shared Services North America, Inc (Fridley, MN)
- …(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 (St. Paul, MN)
- …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
- Fairview Health Services (Burnsville, MN)
- …Women and Children's Service Line, in collaboration with the Ambulatory Director of Women's Services . Assures the coordination, direction, and collaboration ... **Job Overview** **M Health Fairview** seeks a Fairview Health Medical Group (FHMG) Medical Director ...delivery of consistently high levels of quality care and service that meets and/or exceeds clinical expectations… more
- Humana (St. Paul, MN)
- …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 (St. Paul, MN)
- …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 (St. Paul, MN)
- … 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 (St. Paul, MN)
- …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 (St. Paul, MN)
- …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