- Elevance Health (NJ)
- ** Medical Director ** _Please note that per...state or territory of the United States when conducting utilization review or an appeals consideration and ... for employment, unless an accommodation is granted as required by law._ The ** Medical Director ** is responsible for the administration of physical and/or… more
- RWJBarnabas Health (New Brunswick, NJ)
- …improvement and utilization measures + Responsible for the development/ review /revision of appropriate Medical Staff governance documents including the ... Director , Medical Affairs- New Brunswick, NJReq...and pursues additional information for effective / comprehensive peer review + Works with the Chief Medical … more
- CVS Health (Trenton, NJ)
- …plans in Aetna's Northeast region but may support other plans when needed. This UM ( Utilization Management) Medical Director will be a "Work from Home" ... and every day. **Position Summary:** Ready to take your Medical Director skills to the next level...responses to members and providers related to precertification, concurrent review , and appeal request. This position is primarily responsible… more
- Sedgwick (Trenton, NJ)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20 hours per week. ... including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering...required to include one (1) to three (3) years utilization review experience and three (3) years… more
- Humana (Trenton, NJ)
- …put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... Medical Director works on problems of diverse scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with… more
- Humana (Trenton, NJ)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with… more
- Highmark Health (Trenton, NJ)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... and improve the care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may… more
- Bristol Myers Squibb (Princeton, NJ)
- …lives. Read more: careers.bms.com/working-with-us . **Position Summary** The Senior Director , Managed Access Programs (MAPs) will be responsible for partnering ... effective data capture. This role reports to the Executive Director , Managed Access. **Key Responsibilities** Strategic Planning : +...key partners (WW TA, DD, legal, compliance, RCO, Country medical teams) to define and develop the managed access… more
- Travelers Insurance Company (Trenton, NJ)
- …influences which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State ... regulations and medical guidelines to establish medical ...Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board… more
- RWJBarnabas Health (New Brunswick, NJ)
- Asst Director Patient Care , Pre/Post SurgicalReq #:0000202858 Category:Leadership Status:Full-Time Shift:Day Facility:RWJ New Brunswick Department:Pre/Post Surgical ... Robert Wood Johnson Place, New Brunswick, NJ 08901 Job Title: Asst Director Patient Care Location: RWJ New Brunswick Department: Pre/Post Surgical Req#: 0000202858… more