- CommuniCare Health Services Corporate (Charleston, WV)
- Medical Director - Physician Since 1984, CommuniCare Health Services has provided superior, comprehensive management services for the development and ... Communities throughout Ohio, Indiana, West Virginia, Virginia, Missouri, Pennsylvania and Maryland. As Medical Director , you will be part of an exciting new… more
- Humana (Charleston, WV)
- …community and help us put health first** The Long-term services and supports (LTSS) Medical Director 's primary responsibility is the review of medical ... 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
- Genesis Healthcare (Hurricane, WV)
- …and work-life balance flexibility, with no weekends! We are seeking a FFS Attending Physician / Medical Director for our Putnam Care Center, located in ... salary for this position is $215000 / year. This is a Dual Role Attending Physician / Medical Director . It is clinical in nature. There is flexibility with the… more
- Genesis Healthcare (Hurricane, WV)
- …and work-life balance flexibility, with no weekends! We are seeking a FFS Attending Physician / Medical Director for our Putnam Care Center, located in ... salary for this position is $215000 / year. This is a Dual Role Attending Physician / Medical Director . It is clinical in nature. There is flexibility with the… more
- Genesis Healthcare (Huntington, WV)
- …center specific goals and priorities. The Advanced Practice Provider collaborates with the Medical Director and/or Attending Physician for patient specific ... this position is $99700 - $114400 / year. AlignMed Partners is a national medical group dedicated to improving health outcomes among residents of skilled nursing and… more
- Humana (Charleston, WV)
- **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...Director may occasionally speak with contracted external physicians, physician groups, facilities, or community groups to support regional… more
- Humana (Charleston, WV)
- …and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, ... a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Charleston, WV)
- …our caring community and help us put health first** The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The ... Behavioral Health Medical Director work assignments involve moderately complex...resolution skills + May speak with contracted external physicians, physician groups, facilities, or community groups to support regional… more
- Evolent (Charleston, WV)
- …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. ... and management staff, other Physicians, and staff whenever a physician `s input is needed or required. As well as,...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… more
- Evolent (Charleston, WV)
- …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 ... and management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will...timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to… more
- Elevance Health (Charleston, WV)
- ** Medical Director Associate** Location: Alternate locations may be considered. This position will work a hybrid model (remote and office). The ideal candidate ... clinical and/or quality activities under the guidance of a Medical Director . May be responsible for supporting...to discuss review determinations. + May participate in a physician on-call rotation for a 24x7 unit. + May… more
- Highmark Health (Charleston, WV)
- …**Job Description :** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and… more
- Travelers Insurance Company (Charleston, WV)
- … Consortiums and other medical resources as appropriate. Train and evaluate physician and non- physician medical review personnel and activities. + Stay ... **What Is the Opportunity?** Lead the strategy and operations of Travelers Claim Medical initiatives focusing on how developments in the broader medical … more
- Sumitomo Pharma (Charleston, WV)
- …highly motivated, and experienced individual for the position of **Senior Director , Commercial Strategy and Launch Lead, Heme/Onc.** **Job Duties and ... conduct market research to understand current treatment journey and identify customer ( physician , payer and patient) needs to support enzomenib adoption + Provide… more
- Huron Consulting Group (Charleston, WV)
- …internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and ... clinical outcomes, create a more consumer-centric healthcare experience, and drive physician , patient and employee engagement across the enterprise. Join our team… more
- Highmark Health (Charleston, WV)
- …years Familiarity with alternative care model designs (eg, patient centered medical home, ACO), alternative reimbursement models (eg, bundled payments), and provider ... background and/or worked as part of a health system or large physician organization **LICENSES or CERTIFICATIONS** **Required** + None **Preferred** + None… more
- Evolent (Charleston, WV)
- … Officer. The CCO will lead the Clinical Operations team and work with medical director leadership to ensure consistent and efficient adjudication of clinical ... Services team, the CCO will also have dotted line oversight over field medical director (FMD) operational responsibilities, provide strategic input into … more
- Highmark Health (Charleston, WV)
- …disease management identification process, and consult with the Organization's Associate Medical Directors and Medical Directors when appropriate, follow-up on ... accordance with our regulatory guidelines. The incumbent develops and implements physician , pharmacy, account, and member educational initiatives that promote the… more
- CenterWell (South Charleston, WV)
- …care plans and interpreting patient needs, while adhering to Company, physician , and/or health facility procedures/policies. + Manages the assignment of caregivers. ... of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. +… more
- Evolent (Charleston, WV)
- …Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director . + Appropriately identifies potential ... providing better health outcomes. **Collaboration Opportunities:** + Works with the physician reviewer to monitor the adverse determination process and ensure… more