- Humana (Annapolis, MD)
- …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 ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- CareFirst (Baltimore, MD)
- …(RN) is to evaluate clinical quality and procedures within the Clinical Appeals & Grievance Department Government Programs (Maryland Medicare and Medicaid). ... training and/or other business-related activities. **ESSENTIAL FUNCTIONS:** + Reviews Clinical Appeals and Grievances documentation written by the clinical … more
- CareFirst (Baltimore, MD)
- …validation, new plan implementations, Prescription Drug Event and Coverage Determination, Appeals and Grievances analysis, policies, and procedures. Work with ... **Resp & Qualifications** **PURPOSE:** Responsible for all key aspects of Medicare Pharmacy operations including formulary and benefits administration and testing,… more