- Highmark Health (Springfield, IL)
- …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... care (hospital, outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care… more
- Humana (Springfield, IL)
- …reports to the Lead Medical Director . **Other duties:** + Identify medical management operational improvements, including those within the medical ... 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 home… more
- Humana (Springfield, IL)
- …reports to the Lead Medical Director .** **Other duties:** + Identify medical management operational improvements, including those within the medical ... 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 home… more
- Centene Corporation (Springfield, IL)
- …the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. + ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a...performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals… more
- Humana (Springfield, IL)
- …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
- Evolent (Springfield, IL)
- …accountability for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director ... Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management , you will be a key member of the...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Humana (Springfield, IL)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... **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 … more
- CVS Health (Springfield, IL)
- …to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs...for board certification(s) and licensure (must remain skilled in medical and management areas during employment). **Pay… more
- Humana (Springfield, IL)
- **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 (Springfield, IL)
- …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 ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Evolent (Springfield, IL)
- …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... utilization management while working in conjunction with the Senior Medical Director . **Qualifications** + MD/DO/MBBS Degree + Current, unrestricted clinical… more
- Evolent (Springfield, IL)
- …for utilization management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:** + MD/DO/MBBS Degree + ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key...Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On… more
- Otsuka America Pharmaceutical Inc. (Springfield, IL)
- As a senior leader within Medical Affairs, the Executive Director will serve as a strategic thought partner and Chief of Staff to the Vice President of ... capabilities aligned with Otsuka's vision, direction, and growth strategy. The Executive Director , Medical Affairs Strategy, Excellence & Operations will lead… more
- Humana (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals ... (Part D & B). The Medical director work assignments involve moderately complex...or clinical group practice management + Utilization management experience in a medical management… more
- Evolent (Springfield, IL)
- …for utilization management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:** + MD/DO/MBBS- Required ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key...Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On… more
- Parexel (Springfield, IL)
- …we are expanding our esteemed Medical Sciences Team and seeking an Associate/ Medical Director to support the growth of our Global Immunology and Inflammation ... Therapeutic Franchise. As an Associate / Medical Director , you will work closely with...protocol Note that this does not include any direct medical advice on patient care or management … more
- Otsuka America Pharmaceutical Inc. (Springfield, IL)
- …functional lead for publication operations within the Nephrology & Immunology Medical Communications team, the Director partners closely with cross-functional ... across the portfolio. The position reports to the Senior Director , Nephrology & Immunology Medical Communications Lead...ensuring consistency across core content, field materials, and other medical channels **Vendor & Budget Management ** +… more
- Merck (Springfield, IL)
- …environment **Planning and Project Management ** + In alignment with Executive Director , Medical Affairs, provides project management to ensure ... **Job Description** **Role Summary** + The Regional Medical Scientific Senior Director Team Lead, RMSD TL, is a credentialed (ie, MD, PhD, PharmD, DO, and OD)… more
- Humana (Springfield, IL)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The ... Corporate Medical Director works on problems of diverse scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical management experience, working with health insurance… more
- Veterans Affairs, Veterans Health Administration (Springfield, IL)
- Summary This position will serve as a Primary Care Physician and Medical Director at our Springfield Community Based Outpatient Clinic (CBOC) location. ... position will serve as a Primary Care Physician and Medical Director at our Springfield CBOC location....Review by stimulating parent services. Ensures that overall quality management is the goal for all Ambulatory care staff.… more