- Centene Corporation (Austin, TX)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical ... implementation of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd Street-Full-Time-Days - Remote ** The Director , Pre ... and coordination of care to improve patient outcomes while controlling costs. The Director collaborates closely with medical staff, vendors, case management, and… more
- Centene Corporation (Jefferson City, MO)
- …hearings, STARS metrics + Previous experience with ensuring high quality medical director training to review Medicare UM and appeals , Clinical review quality ... and cross functional stakeholders across the enterprise. + Provide medical leadership for all utilization management ( appeals ),...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- CVS Health (Hartford, CT)
- …(work at home) based anywhere in the US.** **Responsibilities of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part ... * Board Certified in ABMS or AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- 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
- CenterWell (Denver, CO)
- …compliance. Manages the Denials Management data analytics, denial and appeal process. The Director , Home Health Grievances & Appeals assists members, via phone ... caring community and help us put health first** The Director Denials Management provides leadership for the audit, appeal...required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills with ability to… 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...protect member PHI / HIPAA information This is a remote position \#LI- Remote Travel: While this is… more
- Community Health Systems (Franklin, TN)
- …of experience in medical billing, revenue cycle, or claims denials and appeals processing required + Prior experience with revenue cycle processes in a hospital ... **Job Summary** The Denials & Appeals Coordinator is responsible for managing, tracking, and...Skills and Abilities** + Strong knowledge of payer guidelines, medical billing practices, and appeal processes. + Proficiency in… more
- Health Care Service Corporation (Albuquerque, NM)
- …development. **Job Summary** This Position Is Responsible For Assigned Aspects Of Medical Policies And Programs. Performs Medical Appeal Reviews And Interacts ... a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or...3 years Managed Care experience This is a Telecommute ( Remote ) role: Must reside withing 250 miles of the… more
- Humana (Washington, DC)
- **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...overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their… more
- Centene Corporation (Phoenix, AZ)
- …fresh perspective on workplace flexibility. **Position Purpose:** Assist the Sr Behavioral Health Medical Director to direct and coordinate the medical ... performance improvement initiatives for capitated providers. + Assists Sr Behavioral Health Medical Director in planning and establishing goals and policies to… more
- Centene Corporation (Indianapolis, IN)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical ... implementation of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Director Medical Affairs Operations- Medical Staff Services -Full-Time -Days ( Remote )** _Our flexible remote opportunities offer ... balance as well as decrease annual commuting expenses_ The Director , Medical Affairs Operations, serves as a... work and preferably have experience working in a remote environment._ Non-Bargaining Unit, 542 - HSO Medical… more
- Martin's Point Health Care (Portland, ME)
- …been certified as a "Great Place to Work" since 2015. Position Summary The Medical Director (MD) provides clinical leadership and direction to the utilization & ... drive short and long-range clinical programming, quality management, and external relationships. The Medical Director reports to the Vice President Health Plan … more
- Evolent (Phoenix, AZ)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... improvement, and clinical excellence. + **This position is 100% Remote and can be completed from any state. Multiple...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… more
- Magellan Health Services (Albuquerque, NM)
- …of care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims ... utilization data. Strong verbal and written communications skills. General Job Information Title Director , Clinical Care Services - New Mexico, Remote Grade 30… 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
- Stanford Health Care (Palo Alto, CA)
- …America) **This is a Stanford Health Care job.** **A Brief Overview** The Director of Reimbursement is a key leadership role within the Controller's Office, ... Department of Health Care Access and Information (HCAI) In addition, the Director of Reimbursement oversees the organization's responses to government audits and… 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