- Blue KC (MO)
- …financial assistance** **Employee discount program** **Job Description Summary:** The Lead Medical Director actively uses their clinical training, experience, ... and/or requested site of service should be authorized. The Medical Director will apply various clinical policies,...decisions that may not have universal agreement, particularly around utilization review activities. + Review … more
- Evolent (Tallahassee, FL)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Sacramento, CA)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Molina Healthcare (Albuquerque, NM)
- …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
- Molina Healthcare (Lincoln, NE)
- …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
- Houston Methodist (Houston, TX)
- …and strategic oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is ... At Houston Methodist, the Sr Director Case Management position is responsible for providing...initiatives aimed at optimizing patient progression of care, aligning utilization review practices, enhancing discharge planning processes,… more
- Elevance Health (Miami, FL)
- ** Medical Director - Florida Medicare Plans** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... in Florida near our Miami or Tampa locations.** The ** Medical Director ** will support the following Florida...and Optimum Healthcare Plans and will be responsible for utilization review case management for these markets.… more
- CVS Health (Nashville, TN)
- …support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization ... Fortune 6 company, has an outstanding opportunity for a Medical Director ( Medical Affairs). This...spend a portion of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals… more
- Centene Corporation (Raleigh, NC)
- … management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review , ... of performance improvement initiatives for network providers. + May assist Chief Medical Director in planning and establishing goals and policies to… more
- Humana (San Juan, PR)
- … 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