- St. George Tanaq Corporation (Harrisburg, PA)
- …Requirements **Required Experience and Skills** + One (1) year of Medicare appeals, medical review , clinical, healthcare regulatory interpretation/application, ... Dispute Resolution Reviewer I Fully Remote*GA Job Type Full-time Description...university in healthcare or related discipline Additional experience in Medicare appeals, medical review , clinical, or other… more
- St. George Tanaq Corporation (Harrisburg, PA)
- …Experience and Skills** + Must have 2-3 years of medical dispute resolution or Medicare appeals, medical review , clinical, or related experience in a healthcare ... Dispute Resolution Reviewer III Fully Remote*GA Job Type Full-time Description...and impartial and supports the determination made, and documents review + Makes sound, independent decisions based on medical… more
- Humana (Harrisburg, PA)
- …group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how… more
- Humana (Harrisburg, PA)
- …and Managed Medicaid. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to… more
- Prime Therapeutics (Harrisburg, PA)
- …our passion and drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs - Remote, Pennsylvania **Job Description** Manages the ... coordination of benefits in the pharmacy program with Medicare Part D plans. Provides the technical and leadership...$74,000.00 - $118,000.00 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our… more
- Humana (Sunbury, PA)
- …our caring community and help us put health first** Are you passionate about the Medicare population, looking for an opportunity to work in sales with the ability to ... as well as, visiting prospects in their homes. Our ** Medicare Sales Field Agents** sell individual health plan products...protection. Please be aware that applicants selected for leader review may be asked to provide their social security… more
- Humana (Harrisburg, PA)
- …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about… more
- Humana (Harrisburg, PA)
- …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
- CVS Health (Harrisburg, PA)
- …to members and providers. As a Medical Director you will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals / ... Second Level Appeals / Expedited Appeals / Appeal Hearings / Special Projects and Committee participation when needed. The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The… more
- Evolent (Harrisburg, PA)
- …for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a meaningful impact ... reviews for cardiovascular cases, serving as a specialty-matched expert reviewer for invasive/interventional cardiology cases (eg, cardiac catheterizations, coronary… more