- Humana (Richmond, VA)
- …Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance , other healthcare providers, clinical group practice management. + ... Utilization management experience in a medical management review organization, such as Medicare...such as Medicare Advantage, managed Medicaid, or Commercial health insurance . + Experience with national guidelines such as MCG(R)… more
- Humana (Richmond, VA)
- …will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus on our 5+ ... 48 states. **Key Responsibilities** **:** + Lead an operational team of Medical Directors to review authorizations and ensure clinical decision-making skills… more
- CRC Insurance Services, Inc. (Richmond, VA)
- …by the division of CRC Group offering the position. CRC Group offers medical , dental, vision, life insurance , disability, accidental death and dismemberment, ... English (Required) **Work Shift:** 1st Shift (United States of America) **Please review the following job description:** Be the CRC Benefits (formerly BenefitMall)… more
- Veterans Affairs, Veterans Health Administration (Norton, VA)
- Summary The Advanced Level Medical Support Assistant (MSA) position serves as a clinic clerk and is a foundational role within the clinic. Responsibilities This is ... team, or other specialty care. Coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization Statistical… more
- Robert Half Accountemps (Fredericksburg, VA)
- …with managing medical denials and appeals. * Proficiency in handling insurance billing and payments accurately. * Exceptional data entry skills with attention to ... legally authorized to work in the United States. Benefits are available including medical , vision, dental, life and disability insurance . Employees hired for our… more
- Elevance Health (Richmond, VA)
- …law. The ** Medical Director Pain Management/Anesthesia Appeals** is responsible for the review of appeals for physical health medical services, to ensure the ... ** Medical Director-Pain Management/Anesthesia Appeals** **Location:** This role enables...reviews with attending physicians or other providers to discuss review determinations + Serve as a resource and consultant… more
- Elevance Health (Richmond, VA)
- ** Medical Director** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... Join us and together we will drive the future of health care. The ** Medical Director** is responsible for the administration of physical and/or behavioral health … more
- Evolent (Richmond, VA)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of...MD review process to reflect appropriate utilization and compliance with… more
- Evolent (Richmond, VA)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in...MD review process to reflect appropriate utilization and compliance with… more
- HCA Healthcare (Fredericksburg, VA)
- …satisfaction and personal growth, we encourage you to apply for our Lead Medical Technologist opening. We promptly review all applications. Highly qualified ... **Description** **Introduction** Do you have the career opportunities as a Lead Medical Technologist you want with your current employer? We have an exciting… more