- Humana (Washington, DC)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and… more
- CenterWell (Washington, DC)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their… 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...overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy ), and reviews for… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review, care management and quality to determine the ... medical effectiveness of proposed treatments and approve care management...reviews, concurrent reviews of inpatient and post-acute care, and appeals . Serves as key resource for network physicians for… more
- AmeriHealth Caritas (Washington, DC)
- **Job Responsibilities** The Director Operations (Healthy DC Plan) reports to the Market President, with oversight of operation services delivered by the ;Healthy DC ... Plan and all relevant federal, state, and local regulatory requirements. The Director Operations Healthy DC Plan is accountable for ensuring the plan's operating… more