- Centene Corporation (Jefferson City, MO)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Supervisory Medical Director at Centene plays a critical role in ... to our members. This role further assists the Senior Medical Director or Chief Medical ...care quality + Oversee and actively participate in the appeals process, ensuring that appeals are handled… more
- Humana (Lincoln, NE)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... case consideration 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 (Frankfort, KY)
- …part of our caring community and help us put health first** The Corporate Medical Director provides medical interpretation and decisions about the ... and determining the best course of action. The Corporate Medical Director provides medical interpretation...the managed care industry including Medicare, Medicaid and or Commercial products + Possess analysis and interpretation skills with… more
- Corewell Health (Grand Rapids, MI)
- …+ Act as lead for expedited requests, gathering relevant information, working with Medical Director to determine if criteria is met. If expedited criteria ... This position will support our non-contracted provider post claim appeals submitted to the health plan. Job Summary Responsible for the analysis, research and… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code… more
- Elevance Health (Woodbridge, NJ)
- **Plan Performance Medical Director - New York Commercial ** Location: This role enables associates to work virtually full-time, with the exception of required ... Medical Director ** serves as the Chief Medical Officer for the health plan's Commercial ...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- Humana (Juneau, AK)
- **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 (Raleigh, NC)
- **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 (Carson City, NV)
- **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
- CVS Health (Austin, TX)
- …of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject matter expertise in clinical and payment policy ... CVS Health company, has an outstanding opportunity for a Medical Director . Ready to take your career...of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable,… more
- Elevance Health (Los Angeles, CA)
- **Behavioral Health Medical Director - Child Psychiatrist** Location: This role enables associates to work virtually full-time, with the exception of required ... be considered. Schedule: Fulltime position, Monday through Friday. The **Behavioral Health Medical Director - Child Psychiatrist** is responsible for completing … more
- CareFirst (Baltimore, MD)
- …DC, or Virginia without restriction; and board certification. Previous experience as medical director for a health care company. **Preferred Qualifications:** + ... reviews, concurrent reviews of inpatient and post-acute care, and appeals . Serves as key resource for network physicians for...Previous experience as medical director for a health care company… more
- CenterWell (Nashville, TN)
- …a part of our caring community and help us put health first** A ** Director of Authorizations & Eligibility** is a senior revenue cycle leader responsible for the ... payer approvals to protect revenue integrity and patient access. The Director partners closely with clinical leadership, operations, finance, compliance, and IT,… more
- Robert Half Finance & Accounting (Carlisle, PA)
- Description We are looking for a dedicated Revenue Cycle Management Director to lead and manage all aspects of our client's revenue cycle operations. This position ... * Oversee the revenue cycle processes for Medicaid, Medicare, managed care, commercial payers, and sliding fee programs. * Establish and enforce billing policies… more
- City and County of San Francisco (San Francisco, CA)
- …service examination process is subject to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or the Civil Service ... is responsible for overseeing a broad range of waterfront commercial , maritime, and public access facilities that are held...item(s) constitute(s) abuse of discretion by the Human Resources Director . Appeals must be submitted directly to… more
- State of Colorado (Golden, CO)
- …of notice or knowledge of the action: Colorado State Personnel Board/State Personnel Director , Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver, ... EDO 00084 Plumber 01/2026 Department Department of Public Safety Division Executive Director 's Office Opening Date 01/05/2026 Closing Date 1/19/2026 5:00 PM Mountain… more
- State of Colorado (Denver, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... the PERA Defined Contribution Plan, plus optional 401K and 457 plans. + Medical and Dental Health Insurance for employees and optional coverage for their dependents.… more
- State of Colorado (Greeley, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... If you have a Colorado Class A or B Commercial Driver's License and are passionate about safety, travel,...keeping them safe. The State of Colorado offers competitive medical , dental and vision insurance, life and disability insurance,… more
- State of Colorado (Craig, CO)
- …Colorado Code of Regulations (CCR) 801-1,State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and ... Are you a Highway/Roadway Maintenance Lead Worker WITH A COMMERCIAL DRIVER'S LICENSE, Class A or B, that allows...test (ie drug test), and DOT physical through our medical provider. + On-call work (rotating basis as well… more
- University of Southern California (Los Angeles, CA)
- …ICD-10-PCS, CPT/HCPCS, DRGs, APCs, and Modifiers-from Medicare, Medi-Cal, MAC, RAC, and commercial insurance companies -when there is refusal or rejection to honor ... appeal. Performs all 1st and 2nd level coding-related denial appeals . All tasks & duties to be perform in...coding of all diagnostic and procedural information from the medical records using ICD-10-CM, ICD-10-PCS, and CPT/HCPCS, and Modifier… more
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