- CommonSpirit Health at Home (Lexington, KY)
- …embody our mission of delivering hope and healing to those we serve. The Director , Clinical Services is responsible for the planning, direction, ... mission, values, strategic goals, and high standards of customer service . + **Ethical Conduct & Compliance:** Uphold the Corporate...all HCHB clinical workflow for both the Director of Clinical Services (DCS)… more
- Sedgwick (Frankfort, KY)
- …Companies Certified as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Director , Clinical Programs **PRIMARY PURPOSE** : ... in claims and/or managed care. Preferred experience in: client services , clinical operations, and or workers comp...clinical programs. + Negotiates changes or improvements to service plan. + Facilitates the reduction of process barriers,… more
- Norstella (Frankfort, KY)
- Sr. Director /VP/ Clinical Delivery Lead, Advisory Services Company: Citeline Location: Remote, United States Date Posted: Nov 4, 2025 Employment Type: Full ... Time Job ID: R-1553 **Description** Sr. Director /VP/ Clinical Delivery Lead, Advisory Services **Reports to** :SVP, Advisory Services **Location** :US/UK… more
- Humana (Frankfort, KY)
- …health, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided ... experience with national guidelines such as NCD/LCD, MCG(R) or InterQual The Medical Director conducts clinical case reviews of requests received by members of… more
- Humana (Frankfort, KY)
- …health, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided ... experience with national guidelines such as NCD/LCD, MCG(R) or InterQual** **The Medical Director conducts clinical case reviews of requests received by members… more
- Molina Healthcare (Lexington, KY)
- …in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in Utilization/Quality ... and case management programs for mental health and chemical dependency services and assists with implementing integrated Behavioral Health care management programs.… more
- CVS Health (Frankfort, KY)
- …Appeals / Special Projects and Committee participation when needed. + The Medical Director will provide clinical , coding, and reimbursement expertise as well as ... in support of medical management programs through participation in clinical team activities. + The Medical Director ...and facilities to support the effective execution of medical services programs by the clinical teams. **Required… more
- Molina Healthcare (Lexington, KY)
- …NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + ... that guide and support the provisions of medical staff services . Maintains a working knowledge of applicable national, state,...including: + 2 years previous experience as a Medical Director in a clinical practice. + Current… more
- Growth Ortho (Lexington, KY)
- …following protocols given by the Physician. Job Relationship 1. Reports to Clinical Supervisor/ Director of Clinical Operations 2. Positions supervised: ... Bluegrass Orthopaedics is hiring a full-time Clinical /Cast Technician in Lexington, KY. The Clinical...signs 2. Cast/DME application and removal 3. Exceptional customer service skills 4. Ability to maintain effective and organized… more
- Humana (Frankfort, KY)
- …outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or ... **Use your skills to make an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided… more
- Cognizant (Frankfort, KY)
- …. Draft and submit the medical necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with ... Nurse you will make an impact by performing advanced level work related to clinical denial management and managing clinical denials from Providers to the Health… more
- HCA Healthcare (Frankfort, KY)
- …of care in 21 states and the United Kingdom. We are looking for a Director Emergency Services for our Frankfort Regional Medical Center team where excellence ... to be an influencer in healthcare? **Apply for our Director Emergency Services role today!** **Job Summary...Collaborates with administrative team and physicians to enhance existing services or develop new service offerings. +… more
- CenterWell (Frankfort, KY)
- …practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The Medical Director may ... **Use your skills to make an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided… more
- Humana (Frankfort, KY)
- …**Use your skills to make an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director … more
- Humana (Frankfort, KY)
- …practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The Medical Director may ... **Use your skills to make an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided… more
- Cardinal Health (Frankfort, KY)
- …development within the market verticals of Access and Patient Support, Clinical Services and Reimbursement Services . The Director will build key customer ... **Together, we can get life-changing therapies to patients who need them-faster.** The Director of Business Development, Patient Hub Services , is responsible for… more
- Humana (Frankfort, KY)
- …to the clinical operations team and healthcare organization. The Medical Director 's work includes computer based review of moderately complex to complex ... , requested level of care, and/or requested site of service should be authorized. All work occurs within a...Typically reports to an Associate Vice President of Health Services , Lead, or Corporate Medical Director , depending… more
- Humana (Frankfort, KY)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... whether requested services , requested level of care, and/or requested site of service should be authorized. All work occurs within a context of regulatory… more
- Humana (Frankfort, KY)
- …uses their medical background, experience, and judgement to make determinations whether requested services , level of care, and/or site of service should be ... support Humana value throughout all activities. **Responsibilities** The Medical Director provides medical interpretation and determinations whether services … more
- Evolent (Frankfort, KY)
- …Medical Director . **Qualifications** + MD/DO/MBBS Degree + Current, unrestricted clinical license in medicine or required specialty + Obtaining and maintaining ... make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a...Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),… more