- 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)
- **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
- CVS Health (Harrisburg, PA)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...and consistent responses to members and providers. As a Medical Director you will focus primarily on… 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** 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
- 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
- Humana (Harrisburg, PA)
- …health first** Humana's Marketing organization is seeking a dynamic and experienced Director , Campaign Planning & Orchestration Leader to join our team. This leader ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
- Humana (Harrisburg, PA)
- …of providing frameworks to maximize available resources to achieve growth. The ** Director ,** **Medicaid Insurance Product Management - Growth & Innovation** will be ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
- Select Medical (Camp Hill, PA)
- …**Inpatient Central Business Office Trainer** (on-site role) **Why work at Select Medical ?** **We are committed to your growth and success:** + Career advancement ... _Availability of benefits is dependent on role with Select Medical ._ Our team offers first-shift, Monday through Friday schedules...be involved in special projects as assigned by the Director of CBO or VP Patient Accounting. **Responsibilities** +… more
- Evolent Health (Harrisburg, PA)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients,… more
- Humana (Harrisburg, PA)
- …organizations in the country. The Healthcare Strategy team supports Humana's Medicare and Medicaid business unit. This business unit, Humana's largest, comprises ... experience leveraging core consulting skills to support delivering some of Medicare and Medicaid's highest priority projects and initiatives, with an emphasis… more
- Evolent Health (Harrisburg, PA)
- …on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization ... as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures...support. + On a requested basis, may function as Medical Director for selecting health plans or… more