- 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
- Elevance Health (Morristown, NJ)
- **Behavioral Health Medical Director - Psychiatrist- NJ Medicaid** Location: The successful candidate will be a board-certified psychiatrist licensed and residing ... time position, 20 hours a week. The **Behavioral Health Medical Director - Psychiatrist- New Jersey** is responsible...state or territory of the United States when conducting utilization review or an appeals consideration and… 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
- CVS Health (Trenton, NJ)
- …ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on review appeal cases for denied ... / Pediatrics (Med / Peds) Board Certification. In the Medical Director role, you will provide oversight...eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management) experience *Active and current state medical… more
- Evolent (Trenton, NJ)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... improving healthcare quality.** + **Computer proficiency** and ability to navigate electronic medical review platforms. + No current exclusions, sanctions, or… 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 (Madison, 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
- Merck (Trenton, NJ)
- **Job Description** **Role Summary:** The Sr. Global Director Medical Affairs (GDMA) is responsible for supporting the execution of scientific & medical ... educational or risk management) to support appropriate and safe utilization of Our Company medicines or vaccines. **Required Qualifications,...Decision Making, Empathy, Market Access, Medical Affairs, Medical Research, Medical Review , … 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
- Stantec (Rochelle Park, NJ)
- …and maintain confidence of C-suite client executives + Monitor profitability - fee utilization against contract value + Review the design for adherence to ... community. **Your Opportunity** Stantec is seeking an Owner's Representative, Project Director for the design and construction of multiple projects. The projects… more