- Highmark Health (Des Moines, IA)
- …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 (Des Moines, IA)
- …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
- Molina Healthcare (Cedar Rapids, IA)
- …Board Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... case management programs for mental health and chemical dependency services . Works closely with the Regional Medical ...* Supports BH committees for quality compliance. * Implements clinical practice guidelines and medical necessity review… more
- Molina Healthcare (Sioux City, IA)
- …NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. ... and procedures that guide and support the provisions of medical staff services . Maintains a working knowledge...experience, including: + 2 years previous experience as a Medical Director in a clinical … more
- Humana (Des Moines, IA)
- …team and fulfill day-to-day leadership responsibilities . Engage the Medical Director whenever additional leadership or clinical support is needed **Use your ... the Healthcare Quality Reporting and Improvement organization. They report to the National Medical Director and lead a diverse team driving education strategy… more
- Access Dubuque (Dubuque, IA)
- …TH Comments **Similar Jobs** Clinical Supervisor - Tri-State Occupational Healt Medical Associates Assistant Director of Clinical Education- Physical ... Clinical Preceptor **UnityPoint Health Finley Hospital** 1 Positions...**FTE/Hours per pay period:** 0.5 + **Department:** Other- Mgmt Services - CRT + **Shift:** variable weekday daytime hours with… more
- Iowa Department of Administrative Services (Rockwell City, IA)
- …meetings, QA/AI meetings, and other meetings as directed by the DOC Medical Director . * Verbalize recommendations or clinical advice to the DOC Pharmacy ... Director . * Make recommendations to the DOC Medical Director on health services ...a Master's Degree in Nursing and certification as a clinical nurse specialist, nurse midwife, nurse practitioner or registered… more
- Prime Therapeutics (Des Moines, IA)
- …our passion and drives every decision we make. **Job Posting Title** Sr Director Clinical Strategy and Oncology Specialty Solutions/PharmD required- REMOTE **Job ... Description** The Senior Director Clinical Strategy and Oncology Specialty Solutions...the development of strategic business roadmaps that integrate both medical and pharmacy solutions. This position will provide leadership… more
- Cognizant (Des Moines, IA)
- …submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... denials including but not limited to referral, preauthorization, medical necessity, non-covered services , investigational/experimental and billing resulting… more
- Highmark Health (Des Moines, IA)
- …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