- CVS Health (Hartford, CT)
- …in the US.** **Responsibilities of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part C appeals (both provider ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal...Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- Humana (Hartford, CT)
- …to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the analysis ... of the Medicare rules, Humana policies and medical necessity. The Medical Director ...includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above… more
- Humana (Hartford, CT)
- **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 (Hartford, CT)
- **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 (Hartford, CT)
- **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
- Evolent (Hartford, CT)
- …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
- Evolent (Hartford, CT)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Hartford, CT)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management ... recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (Hartford, CT)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... request and provides clinical rationale for standard and expedited appeals . + Utilizes medical /clinical review guidelines and...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Trinity Health (West Springfield, MA)
- …The Director , Quality Improvement and Compliance, in collaboration with the Medical Director , is responsible for developing and implementing the annual QI ... implement the annual Quality Improvement (QI) Plan with the Medical Director + In conjunction with ...compliance with CMS regulations. Has overall responsibility for the Medicare Part D fraud, waste and abuse Compliance Program.… more