- CareFirst (Baltimore, MD)
- …business needs and work activities/deliverables that week. **ESSENTIAL FUNCTIONS:** + Directs the Medical Review and Appeals units and manages multiple ... managed care or health insurance environment with a focus on Clinical Medical Review and Appeals and Grievances. **Preferred Qualifications:** + Applicants… more
- 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)
- …how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... caring community and help us put health first** The Medical Director relies on medical ...group practice management. + Utilization management experience in a medical management review organization, such as Medicare… 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 relies on medical ...group practice management. + Utilization management experience in a medical management review organization, such as Medicare… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review , care management and quality to determine the ... needs of members. We are looking for an experienced Medical Director in the greater Baltimore /...reviews, concurrent reviews of inpatient and post-acute care, and appeals . + Oversees all activities of utilization review… more
- Intermountain Health (Annapolis, MD)
- … necessity. In addition, Physician shall work closely with the Medical Director (Executive/Community/Rural), Nursing Administrator, Case Management Director ... coach physicians and other clinicians in appropriate documentation of medical necessity for hospital admissions and other diagnostic and...for appeals in coordination with R1 Central Appeals Unit ("CAU"). + Attend System Utilization Review… more
- Highmark Health (Annapolis, MD)
- …process, and consult with the Organization's Associate Medical Directors and Medical Directors when appropriate, follow-up on appeals in accordance with our ... utilization management programs, and case/ disease management initiatives; providing clinical review and decisions for physician and member appeals and… 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