- Humana (Annapolis, MD)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- Humana (Annapolis, MD)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... caring community and help us put health first** The Medical Director actively uses their medical...group practice management. + Utilization management experience in a medical management review organization, such as Medicare… more
- Evolent Health (Annapolis, MD)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you will be a key member of ... review process. Responsible for the quality of utilization review determinations, including appeals . + Provides input...questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into… more
- Humana (Annapolis, MD)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... caring community and help us put health first** The Medical Director actively uses their medical...other healthcare providers + Utilization management experience in a medical management review organization, such as Medicare… more
- Humana (Annapolis, MD)
- **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 operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all...group practice management. + Utilization management experience in a medical management review organization, such as Medicare… more
- Evolent Health (Annapolis, MD)
- …mission. Stay for the culture. **What You'll Be Doing:** As a Behavioral Health Field Medical Director will be a key member of the utilization management team. ... scrubs to jeans. **Collaboration Opportunities:** Evolent Health is looking for a Behavioral Health Medical Director to be a member of the Evolent clinical team.… more
- Elevance Health (Woodlawn, MD)
- …Services. + Medicare Integrity Operations includes but is not limited to: Medical Policy/ Review including any CMS funded demonstration projects, the analysis ... ** Director I Medicare Operations** **Location:** This position will work a hybrid...of data to review the impact of medical policy application as well as… more
- Highmark Health (Annapolis, MD)
- …and improve the care of our members. **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may ... determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned.… more
- CareFirst (Baltimore, MD)
- …distinct units: Commercial UM intake and call center, Commercial outpatient medical pre-authorization review , Commercial inpatient and outpatient behavioral ... health review , Medicare intake and medical pre-authorization review , Medicaid / Medicare intake, and Medicaid / Medicare medical pre-authorization … more
- CareFirst (Baltimore, MD)
- …years clinical and administrative experience in a managed care setting. + Previous experience as medical director for a health care company. + At least 5 years ... information system, conduct medical necessity and benefit determinations for medical services (pre-service, concurrent and retrospective), appeals , and … more
- Lutheran Immigration and Refugee Service (Baltimore, MD)
- …a small caseload of clients before USCIS, the Executive Office for Immigration Review , and the Board of Immigration Appeals , including attending immigration ... organization, then we have the opportunity for you! Reporting to the Director for Legal Affairs, the Immigration Legal Services Managing Attorney will work… more
- Evolent Health (Annapolis, MD)
- …on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization ... within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure...support. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Prime Therapeutics (Annapolis, MD)
- …**Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the ... as needed to discuss cases and problems. + Utilizes medical /clinical review guidelines and parameters to assure...decisions. + On a requested basis, may function as Medical Director for select health plans or… more
- Evolent Health (Annapolis, MD)
- …timeframe of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical /clinical review guidelines and parameters to ... assure consistency in the MD review process to reflect appropriate utilization and compliance with...timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to… more