- Humana (Austin, TX)
- …to the clinical operations team and healthcare organization. The Medical Director 's work includes computer based review of moderately complex to complex ... quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will... clinical scenarios, review of all submitted clinical records, prioritization… more
- Humana (Austin, TX)
- …knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex clinical scenarios, review of ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical … more
- BAYADA Home Health Care (Austin, TX)
- …about BAYADA Benefits, click here (https://www.bayada.com/benefits/) . **Responsibilities:** + Review clinical information for appropriateness, congruency, and ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding ...and meeting business and development goals. This is a **non- clinical ** role (Note: Clinical opportunities are also… more
- Elevance Health (Grand Prairie, TX)
- …improvement tools offered to clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management. ... management models for our National Account clients. The medical director will be responsible for supporting the clinical...or territory of the United States when conducting utilization review or an appeals consideration and cannot be located… more
- HCA Healthcare (Richardson, TX)
- …and mentoring of program faculty and staff, under the direction of the Program Director or Dean. + Review curriculum regularly in collaboration with faculty to ... more about Galen! (https://galencollege.edu/about) **Position Overview:** The Associate Program Director provides oversight and direction to applicants, enrolled students,… more
- Elevance Health (TX)
- …staff including Medical Director Associates. May be responsible for an entire clinical program. **How will you make an impact:** + Supports clinicians to ensure ... responsible for an entire clinical program and/or independently performs clinical reviews. The Medical Director typically has program management… more
- Elevance Health (Grand Prairie, TX)
- …**Medical Director Pain Management/Anesthesia Appeals** is responsible for the review of appeals for physical health medical services, to ensure the appropriate ... Director Associates. May be responsible for an entire clinical program. **How you will make an impact:** +...reviews with attending physicians or other providers to discuss review determinations + Serve as a resource and consultant… more
- Humana (Austin, TX)
- …experience with national guidelines such as NCD/LCD, MCG(R) or InterQual The Medical Director conducts clinical case reviews of requests received by members of ... part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home… more
- Humana (Austin, TX)
- …community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical ... consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director 's work includes computer based review of moderately complex to… more
- HCA Healthcare (El Paso, TX)
- …limits? Our Las Palmas Medical Center team is looking for a(an) Neonatal ICU Director . HCA Healthcare is an advanced healthcare network that has committed up to $300 ... services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts,… more