- Humana (Austin, TX)
- …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests ... for services. The Medical Director work assignments involve moderately complex...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Houston Methodist (Katy, TX)
- …medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This ... procedures, and provides quality reviews. Reports results of key performance metrics to director on a timely basis. **FINANCE ESSENTIAL FUNCTIONS** + Assists in the… more
- CenterWell (Austin, TX)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- CVS Health (Austin, TX)
- …will perform concurrent and prior authorization reviews with peer to peer coverage of denials. * Appeals - The medical director will perform appeals in ... services to its membership. Aetna is looking for a medical director to be part of a...Two (2) + years of experience in managed care ( Medicare and/or Medicaid) MD or DO; Board certification in… 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 (San Antonio, 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
- Centene Corporation (Austin, TX)
- …quality accreditation standards. + Actively practices medicine **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
- 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
- CVS Health (Austin, TX)
- …process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject ... 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