• Medical Director - Medicare…

    CVS Health (Hartford, CT)
    …in the US. Responsibilities of this Medical Director role are related to Medicare Appeals . * Direct daily work on part C appeals (both provider and ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal...Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
    CVS Health (09/04/25)
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  • Corporate Medical Director…

    Humana (Hartford, CT)
    … (CMD) relies on medical background to review 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 regarding the… more
    Humana (09/05/25)
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  • Medical Director - Medicare…

    Humana (Hartford, CT)
    …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
    Humana (09/06/25)
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  • Medical Director - National…

    Humana (Hartford, CT)
    …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests ... for services. The Medical Director work assignments involve moderately complex...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
    Humana (09/12/25)
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  • Appeals and Grievances Clinical Specialist…

    Healthfirst (CT)
    …productivity and quality for each Specialist against expectations + Prepare cases for Medical Director Review ensuring that all pertinent information (ie case ... of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of… more
    Healthfirst (09/09/25)
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  • Medical Director - Acute Rehab Team

    Humana (Hartford, CT)
    **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... to operationalize this knowledge in their daily work specifically for DSNP. The Medical Director 's work includes computer-based review of moderately complex to… more
    Humana (09/11/25)
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  • Medical Director Aetna Duals Center…

    CVS Health (Hartford, CT)
    …will perform concurrent and prior authorization reviews with peer to peer coverage of denials. * Appeals - The medical director will perform appeals in ... services to its membership. Aetna is looking for a medical director to be part of a...Two (2) + years of experience in managed care ( Medicare and/or Medicaid) MD or DO; Board certification in… more
    CVS Health (08/31/25)
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  • Medical Director - Northeast Region

    Humana (Hartford, CT)
    **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
    Humana (07/25/25)
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  • Field Medical Director , Cardiology

    Evolent (Hartford, CT)
    …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
    Evolent (08/15/25)
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  • Field Medical Director…

    Evolent (Hartford, CT)
    …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
    Evolent (07/30/25)
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