- Harbor Health Services, Inc. (Mattapan, MA)
- …those upon request of utilization or finance department. Works with UM RNs and Senior Medical Director to deny claims when appropriate. Attends IDT meetings ... improvement plans, and assess outcomes. Promotes the appropriate use of InterQual's medical management treatment guidelines. Ensures controls are established to… more
- Aveanna Healthcare (Madison, WI)
- ** 20% Incentive Plan ** Position Overview The Area Executive Director (AED) is responsible for the administrative, operational, and leadership oversight of a ... branches and operational leadership. Essential Job Functions The Area Executive Director is responsible for directly managing all essential operational and… more
- University of California Santa Cruz (Santa Cruz, CA)
- …to support health and well-being. Here is a sample of benefit options: Medical , dental, and vision insurance plans UC Retirement Pension Plan Optional life, legal, ... UC Santa Cruz (UCSC) Student Health Services (SHS) is a full-service medical facility offering clinical, educational, and psychological support to UCSC students. SHS… more
- Johns Hopkins University (Chicago, IL)
- …compensation claims . To expand clinic services and reach. Provide crisis management /intervention, as needed. Provide general medical advice to the PepsiCo ... the PepsiCo/JHU partnership. The position also works closely with the Executive Director and Division Administrator of the Division of Occupational and Environmental… more
- Humana (Juneau, AK)
- …Typically reports to Lead depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by ... **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
- Humana (Raleigh, NC)
- …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
- CenterWell (Tallahassee, FL)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... of situations or data requires an in-depth evaluation of variable factors. The Medical Director provides medical interpretation and decisions about the… more
- MyFlorida (Orlando, FL)
- OPERATIONS & MGMT CONSULTANT MGR - SES - 79010568 1 Date: Dec 12, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... Requisition No: 866780 Agency: Business and Professional Regulations Working Title: OPERATIONS & MGMT CONSULTANT MGR - SES - 79010568 1 Pay Plan: SES Position… more
- Guthrie (Cortland, NY)
- …as necessary with the hospital Business Office, physician offices, Care Coordination, Medical Director and other hospital departments as appropriate. + Serves ... Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination,...requirements and to assist in ensuring generation of clean claims in a timely manner + Securing authorization as… more
- Guthrie (Sayre, PA)
- …Leads any payer specific external claim audit activity, worked in combination with Management , Compliance, Medical Records and Clinical Operations. 9. Serves as ... Insurance Billing Specialists I and related support staff. Works closely with Director , Manager, Supervisor and Application Analyst on day to day priorities and… more
- Fluor (Greenville, SC)
- …and the Intelligence Community. **Job Description** This position assists in the management and execution of the Prime Contract in conjunction with the Project ... Director and Law Department. Complexity of projects and the...integrated with the project core team. Undertake Prime Contract management execution activities in accordance with the Prime Contract… more
- Walmart (Bentonville, AR)
- …department. This leader will drive innovation, process improvement, and best-in-class claims management , ensuring alignment with industry best practices and ... **Position Summary ** The Senior Director , Walmart Claims Services Strategy and...(WCS) is dedicated to delivering efficient, accurate, and customer-focused claims management across enterprise. The organization is… more
- Ryder System (Cheyenne, WY)
- …clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **Summary** The Director Claims directs activities within the General and ... Auto Liability Claims , Physical Damage Repairs and Property and Cargo Claims including the management of loss control activities and third-party provider… more
- AIG (Jersey City, NJ)
- Claims Complex Director - Healthcare Professional... portfolio of the most complex and high exposure medical malpractice (and some GL) claims at ... Liability (HPL) Join us as a Claims Complex Director to take on key...+ Keeps abreast of significant changes in the law, claims and industry trends (not limited to medical… more
- Humana (Honolulu, HI)
- …help us put health first** The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director ... of diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- Centene Corporation (Richmond, VA)
- …everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization ... enhancing data accuracy, and driving efficiency to support timely and compliant claims outcomes. + Leads utilization management team on performance, improvement,… more
- CVS Health (Hartford, CT)
- …it all with heart, each and every day. **Position Summary:** The Lead Director of Software Engineering is responsible for leading engineering teams that support the ... modernization of legacy systems-primarily IBM Mainframe platforms-used for commercial claims routing, adjudication, and operational reporting. This role ensures the… more
- Aspen Dental (Springfield, IL)
- …proper handling of all claims . Under the general direction of the Director of Risk Management , the Manager is responsible for mitigating, reporting, and ... as a **Risk Management , Claims Manager.** **Job Summary:** The Risk Management Claims Manager will manage the administration of claims for incidents… more
- UNC Health Care (Chapel Hill, NC)
- …health and well-being of the unique communities we serve. **Summary** : Reporting to the Director of Claims & Litigation, the Claims and Litigation Manager ... self-insurance liability programs. This position handles internal investigation process of claims , including analysis of medical records, interviews with… more
- BrandSafway (Atlanta, GA)
- …collaboration with the Senior Counsel for Insured Litigation and the Senior Director - Global Risk Management perform comprehensive internal claim/reserve ... direction of the Senior Counsel - Insured Litigation and Claims will (1) manage assist with managing "Insured Litigation...parties like actuaries, brokers and insurance carriers. Support Senior Director - Global Risk Management as needed… more
