- Highmark Health (Austin, TX)
- …responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using ... Medical Policy criteria sets to evaluate the ...or Public Health **EXPERIENCE** **Required** + 5 years in Clinical , Direct Patient care (hospital, outpatient, or private practice)… more
- Elevance Health (Grand Prairie, TX)
- …our care management models for our National Account clients. The medical director will be responsible for supporting the clinical vision and implementation ... access to the health improvement tools offered to clients/ members. The medical director provides clinical expertise in all aspects of utilization review… more
- Humana (Austin, TX)
- …Humana policies, clinical standards, and (in some cases) contracts. The Medical Director provides medical interpretation and decisions about the ... experience with national guidelines such as NCD/LCD, MCG(R) or InterQual The Medical Director conducts clinical case reviews of requests received by members… more
- Veterans Affairs, Veterans Health Administration (Amarillo, TX)
- … Director -Physician) within the Geriatric and Extended Care (GEC) Service. The HBPC Medical Director will provide clinical care within the GEC service ... audits, and review JC, LTCI, OIG, OMI, and others. Clinical Responsibilities: The HBPC Medical Director , in collaboration with the HBPC interdisciplinary… more
- CVS Health (Austin, TX)
- …First Level Appeals / Special Projects and Committee participation when needed. The Medical Director will provide clinical , coding, and reimbursement ... in support of medical management programs through participation in clinical team activities. The Medical Director will act as lead business and … more
- CVS Health (Austin, TX)
- …/ Appeal Hearings / Special Projects and Committee participation when needed. The Medical Director will provide clinical , coding, and reimbursement expertise ... / Pediatrics (Med / Peds) Board Certification. In the Medical Director role, you will provide oversight...directing case management when necessary. The Medical Director will act as a business and clinical… more
- Molina Healthcare (Austin, TX)
- …NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. ... + 3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. +… more
- HCA Healthcare (Mckinney, TX)
- …Summary:** HCA Healthcare Pathology Services and their North Texas Division is seeking a Pathology Medical Director to be based at Medical City McKinney in ... + AP and CP Board Certification required + 2 years of hospital-based Medical Director experience preferred + Recent experience performing frozen sections +… more
- HCA Healthcare (Dallas, TX)
- …and assessments in collaboration with both hospital Case Management and the Rehab Medical Director . The Clinical Rehabilitation Specialist works closely with ... on-site and off-site clinical evaluation to assist Rehab Medical Director in determining appropriateness of patient for admission. . Provides information… more
- Humana (Austin, TX)
- **Become a part of our caring 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 director work assignments involve moderately complex...CMS-recognized Compendia, NCCN, Humana Pharmacy Policies and Procedures, and clinical literature as appropriate. Medical Directors will… more
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