- CenterWell (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Humana (Springfield, IL)
- **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...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Humana (Springfield, IL)
- …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 ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Elevance Health (Chicago, IL)
- **Clinical Operations Associate Medical Director ** **Carelon Medical Benefit Management** **Genetic Testing Utilization Management/Review** **Virtual:** This ... domains, including radiology, cardiology and oncology._ The **Clinical Operations Associate Medical Director ** is responsible for supporting the medical… more
- CVS Health (Springfield, IL)
- …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...review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to… more
- CVS Health (Springfield, IL)
- …Michigan, Kansas and Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to ... a regional role that primarily supports the Aetna Better Health Plan of Illinois. This UM (Utilization Management) Medical Director will be a "Work from… more
- Humana (Springfield, IL)
- …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
- CVS Health (Buffalo Grove, IL)
- …and best practices in the development and maintenance of programs supported by Medical Affairs, drives the regulatory strategy of UM programs and supports ... efficiencies. + Manage the maintenance and external requests of Medical Affairs UM Policies and Procedures. +...across organization by supporting all Heartbeat page maintenance throughout Medical Affairs. + Work with the Lead Director… more
- Evolent (Springfield, IL)
- …participate in meetings as assigned with practices and/or payers. Will work with the Director of UM to ensure client satisfaction. Perform all peer clinical ... under the auspices of the office of the Chief Medical Officer. **ESSENTIAL DUTIES AND RESPONSIBILITIES** : include the...with one of the cardiologists. Responsible for coordinating with UM staff to ensure timely and accurate communication of… more
- Rush University Medical Center (Chicago, IL)
- …care. Applies criteria, performs concurrent review process. Works with physicians and Medical Director regarding Case issues and concurrent denials as indicated. ... **Job Description** Location: Chicago, Illinois Business Unit: Rush Medical Center Hospital: Rush University Medical Center Department: Care Management **Work… more