- Humana (Des Moines, IA)
- **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 (Des Moines, IA)
- …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 ... work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference...with compensated days off during the work week The Medical Director 's work includes reviewing of all… more
- CenterWell (Des Moines, IA)
- **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 (Des Moines, IA)
- …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
- Molina Healthcare (Iowa City, IA)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Molina Healthcare (Des Moines, IA)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- Evolent (Des Moines, IA)
- …Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, ... that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers.... + Appropriately identifies and refers quality issues to UM Leadership. + Appropriately identifies potential cases for Care… more
- Datavant (Des Moines, IA)
- …appropriate letter language to author appeal letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted ... + Work directly with the provider(s) and health plan Medical Director as needed to facilitate timely...table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred + Knowledge of CMS, State Regulations,… more
- Humana (Des Moines, IA)
- …the Regional Vice President of Health Services (RVP) and Health Services Director (HSD). This position focuses on enabling connections with providers, supporting ... for provider partners regarding utilization management operations questions, interfacing with central UM team. + Collaborate with the delegation team to identify and… more