- CenterWell (Washington, DC)
- …**Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization ... **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health… more
- Evolent (Washington, DC)
- …setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional cardiology ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management … more
- Humana (Washington, DC)
- … Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care received ... caring community and help us put health first** The Medical Director actively uses their medical...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Washington, DC)
- … Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in the ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Washington, DC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... policies. When necessary, cases are escalated to the Medical Director for further review. The reviewer...and weekends based on business needs **Responsibilities** + Conduct utilization management reviews by assessing medical… more
- Evolent (Washington, DC)
- …for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director in ... , you will be a key member of the utilization management team. We can offer you...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Evolent (Washington, DC)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Evolent (Washington, DC)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... you will be a key member of the utilization management team. We can offer you...management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:**… more
- Humana (Washington, DC)
- …health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management ... caring community and help us put health first** The Medical Director actively uses their medical...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Highmark Health (Washington, DC)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community… more
- Evolent (Washington, DC)
- …in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a...Oncology, you will be a key member of the utilization management team. We can offer you… more
- Humana (Washington, DC)
- …hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management ... caring community and help us put health first The Medical Director actively uses their medical...adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday -… more
- Humana (Washington, DC)
- …Integrated Delivery Systems, health insurance, or clinical group practice management + Utilization management experience in a medical management ... caring community and help us put health first** The Medical Director relies on broad clinical expertise...with prior experience participating in teams focusing on quality management , utilization management , or similar… more
- Evolent (Washington, DC)
- …in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... Radiology you will be a key member of the utilization management team. We can offer you...Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Humana (Washington, DC)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The ... Corporate Medical Director works on problems of diverse scope and complexity...skills with prior experience leading teams focusing on quality management , utilization management , discharge planning… more
- NANA Regional Corporation (Herndon, VA)
- We are seeking a dynamic Director of Business Development and Capture for our Emerging Markets Group (EMG). This role demands a highly motivated, self-starting ... across the full business development lifecycle - identification, capture management , solutions development, proposal writing/reviewing, and post-award handoff. The … more
- Organon & Co. (Washington, DC)
- **Job Description** **The Position** The Regional Payer Account Director (RPAD) reports directly to the Executive Director , Regional Payer Accounts. The RPAD ... generating potential solutions that enhance partnership. Collaborating with the National Account Director , the RPAD participates in the development of, as well as… more
- Evolent (Washington, DC)
- …we're redefining how care is delivered for individuals facing cancer. As a Performance Suite Medical Director in Medical Oncology, you will play a pivotal ... review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation. **Core… more
- Travelers Insurance Company (Washington, DC)
- … capabilities to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon ... Opportunity?** Lead the strategy and operations of Travelers Claim Medical initiatives focusing on how developments in the broader...Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the… more