- Humana (Topeka, KS)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… 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 ... for all of Sharp Health Plan products, (Commercial, Exchange, Medicare , POS/PPO) services, and oversees the health care needs...+ 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …and implementation of the Children's Behavioral Health (BH) Carve-In program. The Medical Director for BH Children's Services has overall accountability for ... of the Quality Management/Utilization Management (QM/UM) Plan, including having the BH Medical Director for Children's Services and participate on the BH… more
- Molina Healthcare (Fort Worth, TX)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care....experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Somatus (Mclean, VA)
- …provides guidance and oversight to all lines of business including Commercial, Medicaid, Medicare , and Special Need Plans (SNPs). The Director , Quality will work ... the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Flexible Paid Time Off (PTO) + Professional… more
- State of Colorado (Pueblo, CO)
- Director Continuity of Treatment Office - Health Professional VII Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4928040) Apply Director ... recruiting events! CDHSCareers Description of Job About the Position: The HP VII, Director , is a new position developed within the newly designed Continuity of… more
- Fallon Health (Worcester, MA)
- …is responsible for the presentation of the member appeal to the FH Medical Director , Center for Medicare /Medicaid Services, contracted reviewer, as ... staff. Work with Team Leaders, Department Managers, Department Chairs and/or Medical Director to resolve member complaints; formulate improvement measures… more
- Commonwealth Care Alliance (Boston, MA)
- …Exercised:** + None **Essential Duties and Responsibilities:** + Extrapolates and summarizes medical information for medical director , consultants, and other ... to either uphold or deny appeal and forwards to Medical Director as needed. + Ensures that...clinical nursing experience is strongly preferred. + Experience in Medicaid/ Medicare grievances and appeals and/or Utilization Review… more
- STG International (Milledgeville, GA)
- …Coordinate Pre-certification sand recertification in accordance with facility policies for Medicare Advantage and + commercial insurance payers. + Interpret the ... coding for accuracy. + Perform administrative duties such as completing medical forms, reports, evaluations, studies, charting, etc., as necessary. + Periodically… more
- State of Colorado (Golden, CO)
- …This supervision entails assigning and evaluating work, handling informal grievances , initiating corrective and disciplinary actions, and participating in the ... This supervision entails assigning and evaluating work, handling informal grievances , initiating corrective and disciplinary actions, and participating in the… more
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