• Medical Director - Appeals

    Elevance Health (Norfolk, VA)
    ** Medical Director - Appeals ( Primary Care-IM or FM)** **Location: This is a hybrid position. Candidates must live within 50 miles of an Elevance Health ... opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
    Elevance Health (09/18/24)
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  • Medical Director - Medical

    CVS Health (Richmond, VA)
    …**Position Summary** CVS Health, a Fortune 4 company, has an outstanding opportunity for a Medical Director - Medical Affairs. We need a Board Certified ... clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director ( Medical Affairs) will report into… more
    CVS Health (08/31/24)
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  • Medical Director -Musculoskeletal…

    Evolent Health (Richmond, VA)
    …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you will be a key member of ... complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of...questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into… more
    Evolent Health (09/10/24)
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  • Associate Medical Director - Genetic…

    Elevance Health (Roanoke, VA)
    **Clinical Operations Associate Medical Director ** **Carelon Health** **Genetics Testing Utilization Review** **Location** : The ideal candidate will live within ... domains, including radiology, cardiology and oncology._ The **Clinical Operations Associate Medical Director ** is responsible for supporting the medical more
    Elevance Health (09/17/24)
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  • Behavioral Health Medical Director

    CVS Health (Richmond, VA)
    …coverage and policies. ** Primary Job Duties & Responsibilities:** Behavioral Health Medical Director + Collaborates with health plan Sr Leadership to ... directors to ensure the delivery of holistic and integrated person-centered care. The Medical Director will be responsible for provider education regarding best… more
    CVS Health (08/31/24)
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  • Field Medical Director

    Evolent Health (Richmond, VA)
    …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director - Physical Health, you will be a key member of the utilization ... jeans. **Collaboration Opportunities:** Evolent is looking for a Field Medical Director to be a member of...restrictions. + 3-5 years of clinical practice in a primary care setting and progressively responsible medical more
    Evolent Health (09/20/24)
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  • Medical Director Case Management

    CVS Health (Richmond, VA)
    …members' health care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing and deploying our ... new markets across the country. Ability to work CST or EST Preferred. ** Primary Duties and Responsibilities:** * Provides clinical oversight of the Dual Eligible… more
    CVS Health (09/20/24)
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  • Medical Director , Medicaid (Remote…

    Highmark Health (Richmond, VA)
    … Doctor or Doctor of Osteopathic Medicine (DO) + Board certification in a primary medical specialty + Active, unrestricted medical state licensure required. ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and… more
    Highmark Health (08/23/24)
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  • Strategy Director

    Elevance Health (Norfolk, VA)
    …black belt or green belt certification will be considered.** **The Strategy Director ** supports Government Business Grievances & Appeals and Government Business ... propose planning and strategy to improve results based on continuous needs assessment. Primary duties may include, but are not limited to: + Partners with executive… more
    Elevance Health (09/11/24)
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  • Physician Clinical Reviewer, Oncology

    Evolent Health (Richmond, VA)
    …on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization ... complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of...support. + On a requested basis, may function as Medical Director for selecting health plans or… more
    Evolent Health (09/20/24)
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  • Academic Operations Coordinator

    Bon Secours Mercy Health (Mechanicsville, VA)
    …care sites and clinicians are recognized for clinical and operational excellence. ** Primary Function/General Purpose of Position** The primary function of the ... Team meetings. + Provide support to the BSMCON Campus Director and Dean of Academic Affairs and the Associate...various reports to include monthly NCLEX results, student grade appeals , and student conduct reports in the Student Information… more
    Bon Secours Mercy Health (09/19/24)
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  • Physician Clinical Reviewer-RBM

    Evolent Health (Richmond, VA)
    …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of...request and provides clinical rationale for standard and expedited appeals . + Utilizes medical /clinical review guidelines and… more
    Evolent Health (09/20/24)
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  • Family Clinical Advocate, Registered Nurse…

    Sharecare, Inc. (Richmond, VA)
    …cost-effective manner. The Clinical Advocate coordinates with the member, their Primary Care Provider, Specialty Care Providers, ancillary services, and all other ... in working with payer to complete prior authorization or appeals process, when necessary. + Abide by Clinical Advocacy...providers or members to the Clinical Advocate Manager or Director when he/she identifies an opportunity for education or… more
    Sharecare, Inc. (08/10/24)
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