- Highmark Health (Honolulu, HI)
- …responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using ... Medical Policy criteria sets to evaluate the ... necessity and appropriateness of the requested treatment of service . Depending on the nature of the case, telephonic… more
- Humana (Honolulu, HI)
- …and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... Humana policies, clinical standards, and (in some cases) contracts. The Medical Director provides medical interpretation and decisions about the… more
- Highmark Health (Honolulu, HI)
- …anchor, including MAQCs and pharmacists, in collaboration with the partnership director who manages non- clinical workforce activity. + **Relationship Management ... :** **JOB SUMMARY** This role will support the leadership team for Clinical Transformation and executive physicians in leading the day-to-day operational model of… more
- Humana (Honolulu, HI)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... , requested level of care, and/or requested site of service should be authorized. All work occurs within a...**Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided… more
- Humana (Honolulu, HI)
- …topics to the clinical operations team and healthcare organization. The Medical Director 's work includes computer based review of moderately complex to ... , requested level of care, and/or requested site of service should be authorized. All work occurs within a...Typically reports to an Associate Vice President of Health Services , Lead, or Corporate Medical Director… more
- Humana (Honolulu, HI)
- **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 make determinations whether requested services , requested level of care, and/or...knowledge in their daily work specifically for DSNP. The Medical Director 's work includes computer-based review of… more
- Always Best Care Senior Services (Honolulu, HI)
- … Director of Nursing (DON) Designee / Director of Patient Care Services Designee to lead our clinical team with heart, integrity, and aloha. Job ... Description: The DON Designee / Director of Patient Care Services (DPCS) Designee...Services (DPCS) Designee is responsible for the overall clinical direction and coordination of home health services… more
- Humana (Honolulu, HI)
- …an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... caring community and help us put health first** The Medical Director relies on medical ...medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with… more
- Evolent (Honolulu, HI)
- …non- clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),… more
- Evolent (Honolulu, HI)
- …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. ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...Inspector General of the Department of Health and Human Services or the General Service Administration (GSA),… more