- CVS Health (Providence, RI)
- …based (work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Regulated Medicare Appeals : * Direct daily ... policy for the enterprise. * Provide ongoing education regarding Medicare policy and appeals to the appeal...Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- Hartford HealthCare (Wethersfield, CT)
- …issues that may arise during the appeals process 4. Partner with the Medical Director and Physician Advisor staff to compose factually sound appeal letters ... at the most reasonable cost for our patients in the current, rapidly changing medical environment. *_Position Summary:_* The Denial and Appeals Nurse is an… more
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Evolent (Providence, RI)
- …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 (Providence, RI)
- …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 (Providence, RI)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Genetic Testing you will be a key member of the utilization ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Evolent (Providence, RI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** **Associate Medical Director - Cardiovascular Medicine (Cardiologist) | Evolent Health** Are you ... to drive meaningful change beyond the bedside? Evolent Health is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in… more
- Highmark Health (Providence, RI)
- …process, and consult with the Organization's Associate Medical Directors and Medical Directors when appropriate, follow-up on appeals in accordance with our ... overall efficiencies. + Manage individual projects for timely review with the Director , Clinical Pharmacy. + Participate in Medicare Stars performance measures… more
- Athena Health Care Systems (Waterford, CT)
- …+ Mails and tracks all Medicare denial letters. + Retrieves/prints and faxes medical records to QIO for any requested appeals . + Assists with compiling ... (CNA) license and experience is required. + Knowledge of medical terminology, filing, typing, computer, and organizational skills. +...on-going education and provides the information to the RCC/MDS Director so that he/she can follow up. + Enters… more
- Grifols Shared Services North America, Inc (Worcester, MA)
- …criteria, including technology options for electronic submission of PA, Letter of Medical Necessity, appeals , step edits, formulary exception requests and ... including HCPs and their staff, Market Access, the US Pulmonary National Sales Director and Regional Sales Directors and SP/Hub partners in the field, supporting… more