- CVS Health (Annapolis, MD)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals … 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)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… 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 ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Bayer (Baltimore, MD)
- …supporting HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals . Develop ... + In depth understanding of Payer/PBM therapy approval requirements (Prior Authorization, Medical Necessity, Denial Appeals , Formulary coverage and payment for… more
- CareFirst (Baltimore, MD)
- …encompasses six distinct units: Commercial UM intake and call center, Commercial outpatient medical pre-authorization review, Commercial inpatient and ... based on business needs and work activities/deliverables that week. The Director , Utilization Management provides strategic leadership of the utilization management… 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