- Elevance Health (Wallingford, CT)
- ** 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
- CVS Health (Hartford, CT)
- …**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
- Evolent Health (Hartford, CT)
- …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
- CVS Health (Hartford, CT)
- …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
- Highmark Health (Hartford, CT)
- … 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
- Daiichi Sankyo Inc. (Hartford, CT)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... around rare diseases and immune disorders. **Summary:** The Associate Director Field Reimbursement (ADFR) is a critical front-line member...member of the DSI oncology Field Reimbursement team. The primary purpose of this role is to serve as… more
- Fair Haven Community Health Care (New Haven, CT)
- …care, regardless of ability to pay. Job purpose Reporting to the Sr. Director of Clinical Operations, the Medical Billing Accounts Receivable Supervisor will ... we are proud to offer a wide range of primary and specialty care services, as well as evidence-based...positively to the greater working environment. Duties and responsibilities Medical Billing Accounts Receivable Supervisor will direct and manage… more
- Evolent Health (Hartford, CT)
- …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 (Hartford, CT)
- …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
- Sharecare, Inc. (Hartford, CT)
- …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