- Excellus BlueCross BlueShield (Rochester, NY)
- …II (in addition to Level I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of ... case reviews and may require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on ARD cases,… more
- Henry Ford Health System (Warren, MI)
- …+ Bachelor of Science Nursing required OR four (4) years Case Management/ Appeal/Utilization Management experience in lieu of bachelor's degree. ... of services - from primary and preventative care to complex and specialty care, health insurance, a full suite...Ford is one of the nation's most respected academic medical centers and is leading the Future of Health:… more
- Kubicki Draper (Miami, FL)
- …in the use of Word, Microsoft Office, PowerPoint & Excel. + Draft and review vital pleadings and motions, respond to discoveries, and drive motions. + Communicate in ... in good standing Benefits We offer competitive pay, top-tier medical insurance, 401(k) with matching, and much more. Why...where you are in your legal journey-from your first case to your hundredth-you'll find the support, challenge, and… more
- Army National Guard Units (Baltimore, MD)
- …or assignment; removal of military member from active or inactive status). Performs complete review of records and other case documentation to ensure that they ... G1, National Guard. Responsibilities (1) Serves as a final reviewer or processor of actions, which may include but...action being taken and that all levels of legal, medical , pay and administrative review have been… more
- Humana (Helena, MT)
- …team and healthcare organization. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, ... quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will...with Case managers or Care managers on complex case management, including familiarity with social… more
- CenterWell (Boston, MA)
- …knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review ... and use of business metrics. + Experience working with Casemanagersor Caremanagerson complex case management, including familiarity with social determinants of… more
- Humana (Little Rock, AR)
- …knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review ... group practice management. + Utilization management experience in a medical management review organization, such as Medicare...with Case managers or Care managers on complex case management, including familiarity with social… more
- Humana (Indianapolis, IN)
- …knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review ... group practice management. + Utilization management experience in a medical management review organization, such as Medicare...with Case managers or Care managers on complex case management, including familiarity with social… more
- AdventHealth (Daytona Beach, FL)
- …or more years of cancer registry abstraction experience + Strong understanding of complex medical conditions and surgical procedures to make clinical judgements ... other conferences and training as appropriate. + Participates in Quality Assurance peer review , as a reviewer and reviewee. Timely correction of abstractions… more
- Centene Corporation (Jefferson City, MO)
- … review activities pertaining to utilization review , quality assurance, and medical review of complex , controversial, or experimental medical ... plan leaders and cross functional stakeholders across the enterprise + Provide medical leadership for all utilization management, pharmacy, case management,… more