- Highmark Health (Washington, DC)
- …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... care (hospital, outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care… more
- Elevance Health (Washington, DC)
- **Clinical Operations Medical Director ** **Carelon Medical Benefit Management ** **Radiation Oncology** **Virtual:** This role enables associates to work ... **Clinical Operations Medical Director ** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions… more
- Humana (Washington, DC)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… more
- Evolent (Washington, DC)
- …accountability for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director ... Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management , you will be a key member of the...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Humana (Washington, DC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... **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 … more
- Humana (Washington, DC)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Washington, DC)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Humana (Washington, DC)
- …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. ... The Behavioral Health Medical Director work assignments involve moderately complex...decisions to internal associates, and possible participation in care management , with clinical scenarios arising from outpatient or inpatient… more
- Evolent (Washington, DC)
- …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... utilization management while working in conjunction with the Senior Medical Director . **Qualifications** + MD/DO/MBBS Degree + Current, unrestricted clinical… more
- Evolent (Washington, DC)
- …for utilization management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:** + MD/DO/MBBS Degree + ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key...Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On… more
- Otsuka America Pharmaceutical Inc. (Washington, DC)
- As a senior leader within Medical Affairs, the Executive Director will serve as a strategic thought partner and Chief of Staff to the Vice President of ... capabilities aligned with Otsuka's vision, direction, and growth strategy. The Executive Director , Medical Affairs Strategy, Excellence & Operations will lead… more
- Evolent (Washington, DC)
- …for utilization management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:** + MD/DO/MBBS- Required ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key...Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On… more
- Humana (Washington, DC)
- **Become a part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals ... (Part D & B). The Medical director work assignments involve moderately complex...or clinical group practice management + Utilization management experience in a medical management… more
- Otsuka America Pharmaceutical Inc. (Washington, DC)
- …functional lead for publication operations within the Nephrology & Immunology Medical Communications team, the Director partners closely with cross-functional ... across the portfolio. The position reports to the Senior Director , Nephrology & Immunology Medical Communications Lead...ensuring consistency across core content, field materials, and other medical channels **Vendor & Budget Management ** +… more
- Elevance Health (Washington, DC)
- **Plan Performance Medical Director ** Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... is granted as required by law. The **Plan Performance Medical Director ** serves as a lead clinician...**How you will make an impact:** + Supports the Medical Management staff to ensure timely and… more
- Parexel (Washington, DC)
- …Patients First, Quality, Respect, Empowerment & Accountability. **Parexel is looking for a Medical Director with a very strong background in Ophthalmology to ... remo** t **ely in the US or Canada.** The Medical Director is a medical ...counterparts + Client-focused approach to work + Excellent time management skills + Excellent verbal and written medical… more
- Howard University Hospital (Washington, DC)
- …research and positive patient outcomes. Howard University Hospital seeks to hire a Director of Medical Staff Services who will embrace our reach and ... with some nights and weekends as needed. As the Director of Medical Staff Services, you will:...Services required Minimum of five year's progressive experience in Medical Staff management , credentialing, and privileging with… more
- Evolent (Washington, DC)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization ... is recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management … more
- Evolent (Washington, DC)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a key member of the utilization ... is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management … more
- Elevance Health (Washington, DC)
- **Plan Performance Medical Director ** _This role requires associates to be in-office 4 days per week, fostering collaboration and connectivity, while providing ... is granted as required by law."_** The **Plan Performance Medical Director ** is responsible for serving as...**How you will make an impact:** + Supports the Medical Management staff to ensure timely and… more