- Humana (Little Rock, AR)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code… more
- Elevance Health (Dearborn, MI)
- ** Medical Director - Commercial ** Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... able to work East Coast time zone hours.** The ** Medical Director ** will be responsible for utilization...will be responsible for utilization review case management for Commercial business in the New England (CT, ME, and… more
- CVS Health (Austin, TX)
- …You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address ... member needs across the continuum of care. + You will support the Medical Management staff ensuring timely and consistent responses to members and providers. + This… more
- Humana (Providence, RI)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- Humana (Salem, OR)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- Humana (Charleston, WV)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... care and for all of Sharp Health Plan products, ( Commercial , Exchange, Medicare, POS/PPO) services, and oversees the health...+ 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons… more
- Humana (Bismarck, ND)
- **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- CVS Health (Hartford, CT)
- …day. **Position Summary** Aetna, a CVS Health company, has an outstanding opportunity for a Medical Director . Ready to take your career to the next level with a ... anywhere in the United States. In this role as Medical Director MPO ( Medical Policy...of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable,… more