- CenterWell (Frankfort, KY)
- …a part of our caring community and help us put health first** The National Medical Director of Clinical Excellence & Safety is a critical leadership role ... of our senior patients at a national scale. As the National Medical Director of Clinical Excellence & Safety, you will play a pivotal role in shaping… more
- BrightSpring Health Services (Louisville, KY)
- …by current industry clinical guidelines, evidence-based medicine, local and national medical management standards and protocols.* Formalizes expert tracking ... Our Company BrightSpring Health Services Overview Director of Clinical Denials Management and...appeal. Creates an effective appeal utilizing relevant and effective clinical documentation from the medical record; supported… more
- Humana (Frankfort, KY)
- …analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides ... caring community and help us put health first** The Medical Director relies on medical ...provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical … more
- Humana (Frankfort, KY)
- **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...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations,… more
- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations,...to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of… more
- Humana (Frankfort, KY)
- …Humana policies, clinical standards, and (in some cases) contracts. The Medical Director provides medical interpretation and decisions about the ... work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations,... guidelines such as NCD/LCD, MCG(R) or InterQual The Medical Director conducts clinical case… more
- Humana (Frankfort, KY)
- … Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert ... caring community and help us put health first** The Medical Director actively uses their medical...work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations,… more
- Merck (Frankfort, KY)
- **Job Description** **Role Summary** The Regional Medical Scientific Director is a credentialed (ie, PhD, PharmD, DNP, MD) therapeutic and disease expert who ... questions about Company products. The work of an Regional Medical Scientific Director is aligned to: Scientific...national and regional SLs to ensure access to medical and scientific information on areas of therapeutic interest… more
- Elevance Health (Louisville, KY)
- **Medicare Medical Director ** Location: This position will work a hybrid model (remote and office). The ideal candidate will must live within 50 miles of one of ... able to work Eastern Time Zone hours. The **Medicare Medical Director ** is responsible for the administration...Director Associates. May be responsible for an entire clinical program. **How you will make an impact:** +… more
- Merck (Frankfort, KY)
- **Job Description** The Regional Medical Scientific Director is a credentialed (ie, PhD, PharmD, DNP, MD) therapeutic and disease expert who engages in ... from SLs, including questions about Company products. The work of a Regional Medical Scientific Director is aligned to: Scientific Exchange, Research, Scientific… more
- Sumitomo Pharma (Frankfort, KY)
- …. **Job Overview** The Sr. Director , Medical Strategy (Rare ... Disease) will be a key member of the Medical Affairs team reporting to the Executive Director...clinical and scientific insights, and help identify unmet medical needs. The job requires conducting peer to peer… more
- Merck (Frankfort, KY)
- …This person _must_ reside in the territory. **Role Summary** + The Oncology Regional Medical Scientific Director - Head & Neck Cancers/Melanoma is a credentialed ... questions about company products. The work of an Regional Medical Scientific Director is aligned to: Scientific...national and regional SLs to ensure access to medical and scientific information on areas of Head &… more
- Evolent (Frankfort, KY)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Sumitomo Pharma (Frankfort, KY)
- …website https://www.us.sumitomo-pharma.com or follow us on LinkedIn. **Job Overview** The Director , Medical Affairs Strategy (Hematology/Oncology) will be a key ... member of the Medical Affairs team reporting to the Executive Director...Affairs function. This individual will lead program coordination with Clinical Development leadership to ensure alignment between Medical… more
- CVS Health (Frankfort, KY)
- …/ Appeal Hearings / Special Projects and Committee participation when needed. The Medical Director will provide clinical , coding, and reimbursement expertise ... Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...directing case management when necessary. The Medical Director will act as a business and clinical… more
- Merck (Louisville, KY)
- **Job Description** We are seeking a Growth and Improvement minded Regional Medical Scientific Director (AKA Medical Science Liaison / MSL) | in Inflammatory ... help drive our Strategic Operating Priorities. **Summary, Focus and Purpose** The Regional Medical Scientific Director ( Medical Science Liaison) is a… more
- Evolent (Frankfort, KY)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Genetic Testing you will be a key member of the utilization ... rationale for standard and expedited appeals. + Utilizes medical / clinical review guidelines and parameters to assure...timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to… more
- Elevance Health (Louisville, KY)
- ** Clinical Ops Associate Medical Director ** **Orthopedic Surgery** **Location:** This is a virtual position. Candidates must reside within 50 miles of an ... autism and depression, and insightful analytics to improve the delivery of care. The ** Clinical Ops Associate Medical Director - Ortho** is responsible for… more
- CVS Health (Frankfort, KY)
- …or managed care organization, and/or at least two (2) years of experience as a Medical Director in clinical practice, and/or at least three (3) years ... Work closely with health plan leadership, the Chief Medical Officer, other Medical Leadership, Pharmacy Director , clinical staff (including those in… more
- Elevance Health (Louisville, KY)
- ** Clinical Operations Associate Medical Director ** **Interventional Pain** **Carelon Medical Benefits Management** **Location:** Alternate locations may ... live within 50 miles of one of our Elevance Health PulsePoint locations. The ** Clinical Operations Associate Medical Director ** is responsible for supporting… more