- CVS Health (Austin, TX)
- …First Level Appeals / Special Projects and Committee participation when needed. The Medical Director will provide clinical , coding, and reimbursement ... effective use of health care resources. This is a remote based (work from home) role. Candidates must have...of medical management programs through participation in clinical team activities. The Medical Director… 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...in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug ... appeals (Part D & B). The Medical director work assignments involve moderately complex...CMS-recognized Compendia, NCCN, Humana Pharmacy Policies and Procedures, and clinical literature as appropriate. Medical Directors will… more
- Humana (Austin, TX)
- …lead Medical Directors performing utilization management for inpatient authorizations training medical director team to assist and facilitate new hires and ... look at appeals rate with denials and overturns. Deliver the upmost consistent medical director decision making. + _Internal Operations and Technology_ _:_… more
- CVS Health (Austin, TX)
- …the US.** Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home. The Medical ... clinical expertise and business direction in support of medical management programs through participation in clinical ...of medical management programs through participation in clinical team activities. Acts as lead business and … more
- CVS Health (Austin, TX)
- …/ Appeal Hearings / Special Projects and Committee participation when needed. The Medical Director will provide clinical , coding, and reimbursement expertise ... effective use of health care resources. This is a remote based (work from home) role. Preferred candidates will...directing case management when necessary. The Medical Director will act as a business and clinical… more
- Humana (Austin, TX)
- …a part of our caring community and help us 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...represents Humana at Administrative Law Judge hearings; exercises independent clinical judgment and decision making on complex issues regarding… more
- Sumitomo Pharma (Austin, TX)
- …seeking a dynamic, highly motivated, and experienced individual for the position of **Associate Medical Director .** The Associate Medical Director will ... Serious Adverse Event Reports (SAEs), and Product Complaints (PCs) + Contributes to medical safety of clinical trials, including monitoring of clinical … more
- Merck (Austin, TX)
- **Job Description** The Executive Director (ED) for US Medical Affairs (USMA) understands Our Company's enterprise level strategies and leads cross-functionally ... the US, including tactical execution by the field Regional Medical Scientific Director (RMSD) teams and is...Insights + Coordinates and leads research and scientific field medical capabilities in alignment with Global Clinical … more
- Merck (Austin, TX)
- …advancing clinical and treatment paradigms **Minimum Education Requirement:** + Medical degree (eg, MD/MB BS or equivalent degree) **Required Experience and ... **Job Description** The Executive Director , Scientific Affairs (EDSA) maximizes meaningful bi-directional scientific exchange with the worldwide clinical and… more