- Centene Corporation (Jefferson City, MO)
- …hearings, STARS metrics + Previous experience with ensuring high quality medical director training to review Medicare UM and appeals , Clinical review quality ... plan leaders and cross functional stakeholders across the enterprise. + Provide medical leadership for all utilization management ( appeals ), pharmacy, case… more
- Evolent (Jefferson City, MO)
- …Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to ... overall accountability for utilization management while working in conjunction with the Senior Medical Director . **Qualifications** + MD/DO/MBBS Degree +… more
- Evolent (Jefferson City, MO)
- …Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to ... expert. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls)...for utilization management while working in conjunction with the Senior Medical Director . **Qualifications -… more
- Evolent (Jefferson City, MO)
- …Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to ... request. + Provides clinical rationale for standard and expedited appeals . + Utilizes medical /clinical review guidelines and...for utilization management while working in conjunction with the Senior Medical Director . **Qualifications -… more
- Evolent (Jefferson City, MO)
- …regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior ... appeals . + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Evolent (Jefferson City, MO)
- …MD provider is recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a...request and provides clinical rationale for standard and expedited appeals . . Utilizes medical /clinical review guidelines and… more
- Evolent (Jefferson City, MO)
- …MD provider is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization ... of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical /clinical review guidelines and parameters to assure… more