- Humana (Harrisburg, PA)
- …or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical ... caring community and help us put health first** The Medical Director relies on medical ...or Surgery specialties + Utilization management experience in a medical management review organization, such as Medicare … more
- CVS Health (Harrisburg, PA)
- …based (work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part ... 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...* Board Certified in ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance &… more
- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Harrisburg, PA)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify … more
- Humana (Harrisburg, PA)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... of the Medicare rules, Humana policies and medical necessity. The Medical Director ...diverse resources, included but not limited to CMS policies, National and Local Coverage Determinations, CMS-recognized Compendia, NCCN, Humana… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… more
- Humana (Harrisburg, PA)
- **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 (Harrisburg, PA)
- **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
- Lancaster General Health (Lancaster, PA)
- **Summary** **Job Description** **POSITION SUMMARY:** The Associate Medical Director , Hospitalist Services is responsible for assisting the Medical ... The Associate director will report to LGHP Medical Director and have a reporting relationship...CMS compliance for inpatient rehab admissions + Participate in National medical conferences and committees as needed… more
- Evolent Health (Harrisburg, PA)
- …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 ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Lancaster General Health (Lancaster, PA)
- …undesirable behaviors, timeliness of charting, coding, quality, fitness for duty, etc. Medical Director Continuing Medical Education functions: + Supervises ... and vision to the community, the health system, the medical group, as well as service line leadership and...+ In support of the Managing Clinician and the Director of Operations, address clinician specific issues including, but… more
- Lancaster General Health (Lancaster, PA)
- …accommodation) to perform the following duties: + Lead and develop the medical and programmatic components of Penn Medicine Advanced Home Health.. + Coordinate ... Prescribe or administer treatment, therapy, medication, vaccinations, and other medical care to treat or prevent illness, disease, or...+ A health care provider in good standing with Medicare , Medicaid, and other federal and state health insurance… more
- Humana (Harrisburg, PA)
- …caring community and help us put health first** The Associate Director , Actuarial Analytics/Forecasting analyzes and forecasts financial, economic, and other data ... medium and long-term financial and competitive position. The Associate Director , Actuarial Analytics/Forecasting requires a solid understanding of how organization… more
- Humana (Harrisburg, PA)
- …our caring community and help us put health first** Humana's seeking a Director of Corporate Communications that is experienced in civic engagement to join working ... remote anywhere in the US. As the Director of Corporate Communications, Civic Engagement, you will serve...for various platforms, including social media, thought leadership, and national partnerships + Build and maintain relationships with media… more
- Humana (Harrisburg, PA)
- …our caring community and help us put health first** The Associate Director , Cloud Architecture designs, builds, and maintains data processing architectures and ... and unstructured data to insights at enterprise scale. The Associate Director , Cloud Architecture requires an in-depth understanding of how organization capabilities… more
- Lancaster General Health (Lancaster, PA)
- …with occasional evening/weekend requirements. **Job Description** **POSITION SUMMARY:** The program director must be fully committed to the Sports Medicine program ... residency faculty and committee meetings. + Participate in the Graduate Medical Education Committee **Clinical** + Maintenance of a continuity Sports Medicine… more
- CVS Health (Harrisburg, PA)
- …care more personal, convenient and affordable. **Job Purpose and Summary:** The Dental Director - Medicare Appeals is an individual contributor who will assure ... + Basic knowledge of dental benefit products and platforms (DMO, PPO, Medicare Advantage) + Strong understanding of clinical quality programs, and clinical… more
- Prime Therapeutics (Harrisburg, PA)
- …legislative/oversight bodies (eg, URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQA- National Committee for ... passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description Summary**… more
- Bayer (Harrisburg, PA)
- …minds to make a real difference, there's only one choice.** **Associate Director - Field Reimbursement - Oncology Philadelphia Territory** **Associate Director ... HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals. Develop collaborative working… more
- Conviva (Harrisburg, PA)
- …of our caring community and help us put health first** The Associate Director , Security Architecture will play a key role in implementing security architecture, ... ensure the enterprise can achieve the enterprise security strategy. The Associate Director , Security Architecture will play a key role in implementing security… more