- Dignity Health (Bakersfield, CA)
- …to the Medical Director of Utilization Management in medical review activities, peer-to-peer consultations, appeals and grievances and other related ... offices primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing… more
- Molina Healthcare (UT)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... second level BH clinical reviews, BH peer reviews and appeals * Supports BH committees for quality compliance. *...Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical … more
- Evolent (Jackson, MS)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... request and provides clinical rationale for standard and expedited appeals . + Utilizes medical /clinical review guidelines and...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Director Governmental Reporting is responsible for ensuring that Houston Methodist meets all internal and external financial and ... governmental reporting requirements. Requirements include Medicare cost reports, Federal Tax Returns Health and Human Services (HHS)/Centers for Medicare and… more
- Molina Healthcare (Fort Worth, TX)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...* Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for… more
- Centene Corporation (Raleigh, NC)
- …benefits including a fresh perspective on workplace flexibility. **We're Hiring: Full time Medical Director in North Carolina.** Centene Corporation is a leading ... of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals . Participates in provider network development and new market… more
- Centene Corporation (Raleigh, NC)
- …of performance improvement initiatives for network providers. + May assist Chief Medical Director in planning and establishing goals and policies to ... of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals . Participates in provider network development and new market… more
- Molina Healthcare (Owensboro, KY)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health...second level behavioral health clinical reviews, peer reviews and appeals . * Supports behavioral health committees for quality compliance.… more
- Humana (Indianapolis, IN)
- …and build collaborative care models in their practices + Coordinates with the Medical Director to integrate the administration and management of behavioral and ... in this role collaborates closely with Clinical Services and the Chief Medical Officer(CMO) to integrate the day-to-day administration and strategic management of… more
- Alameda Health System (Oakland, CA)
- …and assists physicians with appeals . Maintains minimal denial rates by Medicare , MediCal , private and contracted payers through appropriate direction of ... Director , Utilization Management + Oakland, CA + Highland...the utilization of healthcare services, including appropriateness, efficiency, and medical necessity of treatments and procedures. + Analyze data… more