- 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
- Humana (Columbus, OH)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director actively uses their medical...management. + Utilization management experience in a medical management review organization, such as Medicare… more
- Evolent (Columbus, OH)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Elevance Health (Lima, OH)
- ** Medical Director -Long Term Support and...state or territory of the United States when conducting utilization review or an appeals consideration and ... health, behavioral health, long term services and supports, and psychosocial needs._ The ** Medical Director -Long Term Support and Services- MyCare OHIO** is… more
- Evolent (Columbus, OH)
- …timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Molina Healthcare (Columbus, OH)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... utilization . * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy … more
- Molina Healthcare (Cleveland, OH)
- …Board Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease… more
- Evolent (Columbus, OH)
- …timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Molina Healthcare (OH)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies… more
- Elevance Health (Mason, OH)
- …unless an accommodation is granted as required by law. The ** Medical Director -Dermatology Appeals** is responsible for the review of appeals for physical ... ** Medical Director -Dermatology Appeals** **Location:** This role...state or territory of the United States when conducting utilization review or an appeals consideration and… more