- CVS Health (Washington, DC)
- …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 (Washington, DC)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- Humana (Washington, DC)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- Somatus (Mclean, VA)
- …the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Flexible Paid Time Off (PTO) + Professional ... well-being + Community engagement opportunities + And more! The Director of Quality, reporting to the AVP of Quality,...guidance and oversight to all lines of business including Commercial , Medicaid, Medicare, and Special Need Plans (SNPs). The… more
- CareFirst (Baltimore, MD)
- …years clinical and administrative experience in a managed care setting. + Previous experience as medical director for a health care company. + At least 5 years ... information system, conduct medical necessity and benefit determinations for medical services (pre-service, concurrent and retrospective), appeals , and … more
- Grifols Shared Services North America, Inc (Baltimore, MD)
- …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
- GE HealthCare (Washington, DC)
- …global supplier of contrast media and molecular imaging agents used to enhance medical imaging exams for major disease area diagnostic and treatment pathways. PDx ... with travel up to 40% required. This position will report to the Director of Patient Services. **Job Description** Roles and Responsibilities . Will be subject… more