- Cognizant (Columbus, OH)
- …payment. . Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in ... the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued member… more
- Elevance Health (Cincinnati, OH)
- …The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical relevance to ... day clinical responsibilities means that the medical director is directly involved in Utilization Management...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Centene Corporation (Columbus, OH)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- Evolent (Columbus, OH)
- …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National...process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Humana (Columbus, OH)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... management. + Utilization management experience in a medical management review organization, such as Medicare... Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management… more
- Humana (Columbus, OH)
- …how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... management. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
- Evolent (Columbus, OH)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Columbus, OH)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Molina Healthcare (Akron, OH)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... + 3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. + Experience… more
- Molina Healthcare (Dayton, OH)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... + 3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. + Experience… more
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