- Organon & Co. (Plymouth Meeting, PA)
- …The Director will also oversee strategic planning and budget management for speaker programs, advisory boards, congress opportunities, and peer to peer ... **Job Description** **The Position** The Strategic Relations Director will play a critical role in shaping Organon's presence and reputation within the dermatology,… more
- CSL Behring (King Of Prussia, PA)
- …collection and submit all reports needed for compliance. 4. Work with Senior Director , Policy Advocacy & Government Affairs, & Legal to interpret and implement ... and compliance support for Audit, Legal or Finance as requested 9. Provide management oversight on the records supporting the disclosure of data to federal and… more
- Lyric (Newtown Square, PA)
- …inform Lyric's clients. + Familiarity with affordability, claims operations, payment integrity, utilization management , medical policy and/or benefit policy ... Explore opportunities at lyric.ai/careers and drive innovation with #YouToThePowerOfAI. The Senior Medical Director is a senior clinical leader who will… more
- CSL Behring (King Of Prussia, PA)
- …audiences -Excellent Strategic Thinking skills -Significant experience in the application and utilization of portfolio management systems and software - - **Our ... **Position Description** **Summary** Lead the Project Management Office for R&D **Main** **Responsibilities & Accountabilities**...continually refine ways in which products can address unmet medical needs and help patients lead full lives. CSL… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview:** The Medical Director , Utilization Management , provides organizational leadership in the operational areas of appeals, utilization ... and related policy and practice initiatives in collaboration with the Corporate Medical Directors, Utilization Management and the Vice President, Medical … more
- Humana (Trenton, NJ)
- … Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care received ... caring community and help us put health first** The Medical Director actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Trenton, NJ)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Trenton, NJ)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... healthcare providers, clinical group practice management . + Utilization management experience in a medical... management operational improvements, including those within the medical director area + Participate in call… more
- Elevance Health (Wilmington, DE)
- …responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for both ... Director ** is responsible for serving as the Operational Medical Director for our care management...director provides clinical expertise in all aspects of utilization review and case management . Provides input… more
- CVS Health (Trenton, NJ)
- …plans in Aetna's Northeast region but may support other plans when needed. This UM ( Utilization Management ) Medical Director will be a "Work from ... and every day. **Position Summary:** Ready to take your Medical Director skills to the next level...and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well… more
- Cognizant (Trenton, NJ)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years'… more
- Evolent (Trenton, NJ)
- …for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director in ... , you will be a key member of the utilization management team. We can offer you...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- UPMC (Media, PA)
- …committees of the PH MCOs. + Reviews the medical aspects of cost and utilization reports generated by Medical Management Information System. + Acts as a ... a qualified individual to fulfill the role of Regional Medical Director in Delaware County, PA. The...Community Care members. This includes significant responsibility for quality management and utilization management and… more
- Evolent (Trenton, NJ)
- …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management … more
- Evolent (Trenton, NJ)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Evolent (Trenton, NJ)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Evolent (Trenton, NJ)
- …in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a...Oncology, you will be a key member of the utilization management team. We can offer you… more
- Highmark Health (Trenton, NJ)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community… more
- Evolent (Trenton, NJ)
- …in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... Radiology you will be a key member of the utilization management team. We can offer you...Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Humana (Trenton, NJ)
- …organization focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with ... 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… more
