- Humana (Springfield, IL)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- Highmark Health (Springfield, IL)
- …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and… more
- The Cigna Group (Springfield, IL)
- …Providers and members, monitors and processes provider requests related to Medical Director Recommendations delivering adverse determinations, and facilitates ... the Initial and Concurrent Review processes and assists the PAC training team with Medical Director unable to approve processes as well as mentoring Field Care… more