- Humana (Trenton, NJ)
- …a 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 preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- 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 and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… 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 ... to AHS affiliated School or Team Organization. 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