- CVS Health (Boston, MA)
- …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 (Boston, MA)
- …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 (Boston, MA)
- **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 (Boston, MA)
- **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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …a member and provider call center, provider correspondence and appeals , clinical review, member correspondence and reconsiderations, enrollment, claims processing, ... provider correspondence associates who research and respond to provider inquires and appeals , build cases, and perform claim adjustments in a dual system… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …with BCBSMA criteria to adjudicate these requests. At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also ... + Perform additional tasks as assigned by the Associate Medical Director of the Physician Psychologist Review...Active clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care… more