- CVS Health (Providence, RI)
- …based (work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Regulated Medicare Appeals : * Direct daily ... policy for the enterprise. * Provide ongoing education regarding Medicare policy and appeals to the appeal...Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- Humana (Providence, RI)
- **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 (Providence, RI)
- **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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Evolent (Providence, RI)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Providence, RI)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Providence, RI)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Genetic Testing you will be a key member of the utilization ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (Providence, RI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** **Associate Medical Director - Cardiovascular Medicine (Cardiologist) | Evolent Health** Are you ... to drive meaningful change beyond the bedside? Evolent Health is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in… more
- Highmark Health (Providence, RI)
- …process, and consult with the Organization's Associate Medical Directors and Medical Directors when appropriate, follow-up on appeals in accordance with our ... overall efficiencies. + Manage individual projects for timely review with the Director , Clinical Pharmacy. + Participate in Medicare Stars performance measures… more
- Grifols Shared Services North America, Inc (Cranston, RI)
- …criteria, including technology options for electronic submission of PA, Letter of Medical Necessity, appeals , step edits, formulary exception requests and ... including HCPs and their staff, Market Access, the US Pulmonary National Sales Director and Regional Sales Directors and SP/Hub partners in the field, supporting… more