- CVS Health (Hartford, CT)
- …remote based (work at home) based anywhere in the US. **Responsibilities of this Medical Director role are related to Medicare Appeals :** * Direct daily work on ... part C appeals (both provider and member /nonparticipating providers). * Provide direct support to appeal nurses...Clinical Practice or Health Care Industry * Medical License ( MD ) or (DO) * An Active state medical license… more
- Elevance Health (Mason, OH)
- **Medical Director -Dermatology Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... for employment, unless an accommodation is granted as required by law. The **Medical Director -Dermatology Appeals ** is responsible for the review of appeals … more
- Elevance Health (Indianapolis, IN)
- ** Appeals Medical Director - Indiana Medicaid** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... required by law. Alternate locations may be considered. The ** Appeals Medical Director ** is responsible for the...to increase effectiveness and quality. **Minimum Requirements:** + Requires MD or DO and Board certification approved by one… more
- Humana (Lincoln, NE)
- …Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately ... of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and support staff to provide Humana members… more
- Elevance Health (Los Angeles, CA)
- **Behavioral Health Medical** ** Director -Psychiatrist** ** Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of ... Monday - Friday. Half day Saturday rotation, once a month.** The **Medical Director ** is responsible for the administration of behavioral health medical services, to… more
- Nuvance Health (Danbury, CT)
- …review criteria during the first level review, discuss with the attending MD to obtain additional clinical information and documentation to support inpatient level ... and delivery of required patient notices (by onsite team member ). These include but are not limited to: HINNs,...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Grant Thornton (Chicago, IL)
- As the Tax Practice & Quality Managing Director , you'll identify the impact of new tax developments and the opportunities that may relate to specialty areas - ... of concepts relevant to federal or state tax enforcement, including audits, appeals , tax litigation, summonses, statutes of limitation, and penalties. + Strong… more
- Evolent (Oklahoma City, OK)
- …the culture. **What You'll Be Doing:** As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency… more
- CVS Health (Tallahassee, FL)
- … director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review, and provider appeals ... for discussions for trend discussions. Attend in-person provider and member meetings as needed. * Develop and guide the...UM and participate in UM front line work and appeals in markets as needed. * Confer directly with… more
- HCA Healthcare (Nashville, TN)
- …accurate coverage. + Provide crucial support to the regulatory compliance team in managing appeals and improving documentation to meet regulatory standards. + ... from the centralized peer-to-peer team and others regarding denials and appeals processes, observation level of care, decisions about admission, patient transitions,… more
- Humana (Juneau, AK)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... of service should be authorized at the Initial and Appeals /Disputes level. All work occurs within a context of...operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Elevance Health (Miami, FL)
- **Clinical Operations Medical Director ** **Medical Oncology** **Carelon Medical Benefit Management** **Virtual** : This role enables associates to work virtually ... employment, unless an accommodation is granted as required by law._ _A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management,… more
- Molina Healthcare (Fort Worth, TX)
- …setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Determines appropriateness and medical ... program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the… more
- Humana (Raleigh, NC)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex clinical… more
- Centene Corporation (Jefferson City, MO)
- …perspective on workplace flexibility. **Position Purpose:** The National Neonatology Medical Director role relies on high impact visionary leadership to drive ... innovative, member -centric solutions designed to shape the future of neonatal...improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies to… more
- HCA Healthcare (Austin, TX)
- …regarding physician credentialing, utilization, and quality profiling. Serves as a member of hospital's peer review committees as requested. Business Development and ... program development, and overall hospital strategy. + Provides medical director services to facility-level physician credentialing, business development, and… more
- CenterWell (Boston, MA)
- …a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health claims. The Medical ... Director , Primary Care work assignments involve moderately complex to...overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their… more
- Evolent (Helena, MT)
- …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 management team. ... of the request and provides clinical rationale for standard and expedited appeals . . Utilizes medical/clinical review guidelines and parameters to assure consistency… more
- Evolent (Helena, MT)
- …mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We ... for utilization management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:** + MD /DO/MBBS Degree +… more
- Evolent (Helena, MT)
- …As a Physician Clinical Reviewer, Interventional Pain Management, you will be a key member of the utilization management team. We can offer you a meaningful way to ... medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s… more