- Humana (Trenton, NJ)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The ... Corporate Medical Director works on problems of diverse scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… 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 ... Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a... Medicare , Medicaid, and third-party guidelines. . Effectively document and… more
- Atlantic Health System (Morristown, NJ)
- …athletes, coaches, and medical staff as indicated 9. Manages and resolves complex grievances related to the medical care provided to athletes 10. Acts as ... AHS affiliated School or Team Organization to autonomously provide medical care to all athletes affiliated with designated School...highest - twelve consecutive times, and the Centers for Medicare and Medicaid Services awarded us again with its… more