- Humana (Austin, TX)
- … (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- Humana (Austin, TX)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Austin, TX)
- …to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the analysis ... of the Medicare rules, Humana policies and medical necessity. The Medical Director 's...includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above… more
- Houston Methodist (Katy, TX)
- …medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This ... HB Epic AR management experience + Strong working knowledge of Facility Medicare (Part A) guidelines. + Problem solving thought leader with proven execution… more
- Humana (Austin, TX)
- **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 (Austin, TX)
- **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
- Molina Healthcare (Austin, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Evolent (Austin, TX)
- …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 (Austin, TX)
- …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
- Humana (Austin, TX)
- …a part of our caring community and help us put health first** The Dental Director is responsible for providing clinical oversight to promote the oral health of the ... This is accomplished by analysis and adjudication of claims, appeals , and potential quality of care issues. The Dental..., and potential quality of care issues. The Dental Director - Texas assists in the design, development, and… more