- Elevance Health (Richmond, VA)
- ** Medical Director - Medicare Fee for...consultant to other areas of the company; particularly the Medical Review and Appeals areas + May be ... and Medicaid Services to transform federal health programs. The ** Medical Director ** is responsible for drafting and...as needed with review of claims. Works with other Medicare Administrative Contractor (MAC) Medical Directors for… more
- Penn Medicine (Bala Cynwyd, PA)
- …provider groups and alternative care settings. Under the direction of the Director of Hospital Compliance, Government Audit and Appeals , receives, reviews, ... leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across… more
- CVS Health (Hartford, CT)
- …of covered benefits in the Commercial and Medicare environment with a focus Medicare policy., This Medical Director provides subject matter expertise in ... CVS Health company, has an outstanding opportunity for a Medical Director . Ready to take your career...of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable,… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Senior CBO Appeals Analyst position requires an in-depth knowledge of healthcare pricing/reimbursement processes and procedures including ... collaboration with the Underpayment Team manager, the Senior CBO Appeals Analyst will work to further the CBO's goals...meetings. 6. Routinely meets with underpayment team manager and director to provide updates on KPI's. 7. Research and… more
- OhioHealth (Columbus, OH)
- …Manager with updates. CGS audits and auditors Working with our legal vendor for Medicare Appeals . Working with OHA and CBSA facilities on wage index ... matter expert in the following areas, S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, Indirect Medical Education, Graduate Medical… more
- Humana (Harrisburg, PA)
- **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
- CVS Health (Springfield, IL)
- …assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ( Medicare /Medicaid) programs and ... Fortune 6 company, has an outstanding opportunity for a Medical Director ( Medical Affairs). This...individual client requested coverage determinations or appeals when appropriate. - Medical Directors will… more
- Evolent (Jackson, MS)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... including development of questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into the types of cases… 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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Molina Healthcare (FL)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more