- Humana (Columbia, SC)
- **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 ... Medical Director work assignments involve moderately complex to complex issues...data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical… more
- Humana (Columbia, SC)
- **Become a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and ... reviewing skilled nursing facility requests. The Medical Director provides medical interpretation and determinations whether services provided by other… more
- Humana (Columbia, SC)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical records,… more
- Humana (Columbia, SC)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... 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
- Highmark Health (Columbia, SC)
- **Company :** Endorsed **Job Description :** **GENERAL OVERVIEW** The Medical Director will provide qualified medical direction and consultation for care ... provide clinical leadership and guidance to the regional interdisciplinary team. The medical director collaborates clinically with the APP to insure standards… more
- Wellpath (Columbia, SC)
- …and point of care support. **How you make a difference** **Are you a skilled Medical Director looking for a flexible opportunity to make a meaningful impact? ... Look no further - we're seeking a dynamic Medical Director to join our team on a part-time basis (20-25 hours per week)!** The Medical Director is a key… more
- Humana (Columbia, SC)
- …a part of our caring community and help us put health first** The Corporate Medical 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 … more
- Evolent Health (Columbia, SC)
- …Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Medical Director , RBM you will be a key member of the utilization management ... for discussion of utilization management decisions. + May function as Medical Director for select health plans or regions, assuming overall accountability for… more
- Humana (Columbia, SC)
- **Become a part of our caring community and help us put health first** The Medical Director 's primary responsibility is the review of medical authorizations ... medical necessity of a given service, level of care, or medical item/supply. The Medical Director 's work assignments involve moderately complex to complex… more
- Highmark Health (Columbia, SC)
- …current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and ... **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions,… more
- CSL Plasma (Columbia, SC)
- …to determine suitability to donate plasma * In conjunction with the Center Medical Director , responds to medically related questions and provides information to ... donor suitability for automated pheresis procedures * Provides limited emergency medical care to donors and staff including administering medication or treatments… more
- Evolent Health (Columbia, SC)
- …on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization ... and/or system support. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for… more
- US Tech Solutions (Columbia, SC)
- …reviewed at our level. If not, then it would be sent for review with our medical director . We would then complete the approval or denial and notify the provider. ... back up review determinations. Identifies and makes referrals to appropriate staff ( Medical Director , Case Manager, Preventive Services, Subrogation, Quality of… more
- Takeda Pharmaceuticals (Columbia, SC)
- …Takeda to advance medical strategy and improve patient outcomes. As part of the US Medical team, you will report to the Director , Field Medical . This is ... to the best of my knowledge. **Job Description** Join Takeda as a Senior Medical Science Liaison - Gastroenterology / Immunology where you will be responsible for… more
- Takeda Pharmaceuticals (Columbia, SC)
- …to advance medical strategy and improve patient outcomes. As part of the US Medical team, you will report to the Director , Field Medical . The territory ... the best of my knowledge. **Job Description** About the role: The Senior Medical Science Liaison is a remote, field-based, external customer-facing member of the US… more
- CSL Plasma (Columbia, SC)
- …regarding suitability to donate plasma. 3 In conjunction with the Center Medical Director and/or Center Physician responds to medically related questions ... immunizations other than red blood cell immunizations. Provides limited emergency medical care to donors and staff, including the administration of medication… more
- Prime Therapeutics (Columbia, SC)
- …of utilization management decisions. + On a requested basis, may function as Medical Director for select health plans or regions, assuming overall accountability ... Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the applicable… more
- Veterans Affairs, Veterans Health Administration (Columbia, SC)
- …of the EDRP application. Responsibilities A full-time position is available for the Medical Director of the Acute Inpatient Psychiatry Team at the Columbia ... (1) Those approved by the Accreditation Council for Graduate Medical Education (ACGME), b) OR [(2) Those approved by...verified practice in the United States), which the local Medical Staff Executive Committee deems to have provided the… more
- Centene Corporation (Columbia, SC)
- …conjunction with other departments to include Provider Relations, Quality as well as the Medical Director for the state assigned to ensure compliance of CMS risk ... a fresh perspective on workplace flexibility. **Position Purpose:** Conduct provider medical record audits, analysis of practice coding patterns, education and… more
- US Tech Solutions (Columbia, SC)
- …back up review determinations. Identifies and makes referrals to appropriate staff ( Medical Director , Case Manager, Preventive Services, Subrogation, Quality of ... Hours Are Less Than 6 Hours Per Weekend Assigned. + Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within… more