- CVS Health (Harrisburg, PA)
- …continuum of our members' health care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing ... and socioeconomic needs. * Partner closely with the Executive Director of Duals and other Duals Care Management...and quality objectives are met. * Consults with plan medical staff regarding adverse determinations, addresses issues related to… more
- WellSpan Health (York, PA)
- …a liaison between physician advisors in the designated geographic area and the Medical Director of Corp. Case Management + Attends CM RN morning report ... as needed and at the direction of the Medical Director of Corp. Case Management Common Expectations: + Fully documents review activities according… more
- Humana (Harrisburg, PA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director relies on medical ...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Humana (Harrisburg, PA)
- …relationships, value-based care, quality metrics, population health, and disease or care management . The Behavioral Health Medical Director may develop ... and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Humana (Harrisburg, PA)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director actively uses their medical...in teams focusing on quality management , utilization management , case management , discharge planning… more
- Humana (Harrisburg, PA)
- … medical management operational improvements, including those within the medical director area + Participate in call rotation + Develop collaborative ... in teams focusing on quality management , utilization management , case management , discharge planning...on size of region or line of business. The Medical Director conducts Utilization Management … more
- WellSpan Health (York, PA)
- …Committees. Co-chair's System Utilization Management Committee. + Works closely with Medical Director to identify trends in payor denials and appeals. + ... Operations Committee Meetings with payers. + Organizes and assists Medical Director with System Utilization Management...the hiring and performance of the support staff for case management across System entities by assisting… more
- Evolent Health (Harrisburg, PA)
- …training classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. ... Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you will be a key member of… more
- J&J Family of Companies (Harrisburg, PA)
- Director , Regulatory Medical Writing (1 of 4)...countries. Remote work options may be considered on a case -by- case basis and if approved by the company. ... - 2406211847W **Description** Johnson & Johnson is currently seeking a Director , Regulatory Medical Writing. The primary location for this position is the United… more
- Highmark Health (Harrisburg, PA)
- **Company :** Endorsed **Job Description :** **GENERAL OVERVIEW** The Medical Director will provide qualified medical direction and consultation for care ... delivery and complex case management for our community-based palliative care...leadership and guidance to the regional interdisciplinary team. The medical director collaborates clinically with the APP… more
- CVS Health (Harrisburg, PA)
- …preferably resides in PA/DE/WV and have a PA/WV/DE License without encumbrances. In the Medical Director role you will provide oversight for medical policy ... clinical / medical programs and expand Aetna's medical management programs to address member needs...and consistent responses to members and providers. As a Medical Director you will focus primarily on… more
- WellSpan Health (York, PA)
- …and non-physician staff within the department. + Provides direct patient care and medical case management services and otherwise performs the duties ... Medical Director -Employee Health and Safety Location:...###@wellspan.org. We will evaluate requests for accommodation on a case -by- case basis. Please note that we will… more
- Evolent Health (Harrisburg, PA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director - Physical Health, you will be a key member of the utilization ... jeans. **Collaboration Opportunities:** Evolent is looking for a Field Medical Director to be a member of...in risk management , claim adjudication, pharmacy utilization management , catastrophic case review, outreach programs, +… more
- Humana (Harrisburg, PA)
- …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...experience post-training providing clinical services + Experience in utilization management review and case management … more
- CVS Health (Harrisburg, PA)
- …management plan, monitoring, and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member ... Apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs. +… more
- UPMC (Carlisle, PA)
- …+ Takes leadership role in concurrent denial process. Works with Care Management Director , Physician Advisor, Attending Physicians and clinical team to ... coverage for major and minor holidays. **Responsibilities:** + Reviews medical record daily to ensure patient continues to meet...+ BSN or related Bachelor's degree preferred. + Previous case management experience preferred. + Knowledge of… more
- Merck (Harrisburg, PA)
- **Job Description** The Executive Director , Global Medical and Scientific Affairs (EDMA) GYN Malignancies is accountable for the development and execution of ... scientific & medical affairs Value and Implementation (V&I) plans for their...and Implementation (V&I) plan, in collaboration with the Executive Director of Scientific Affairs (EDSA), that guides TA scientific… more
- CVS Health (Harrisburg, PA)
- …**Position Summary** Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Cardiology) that can be remote based, work from home. This ... can be remote based anywhere in the US. The Medical Director (Cardiology) will be a Subject...will lead all aspects of utilization review/quality assurance, directing case management . In this role you will… more
- CVS Health (Harrisburg, PA)
- …role and have a current state medical license without encumbrances.** In the Medical Director role you will provide oversight for medical policy ... evaluation of clinical/ medical programs and expand Aetna's medical management programs to address member needs...In addition you will oversee utilization review/quality assurance, directing case management . In this role you'll provide… more
- Highmark Health (Harrisburg, PA)
- …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan;...need. **Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral… more