- Humana (St. Paul, MN)
- **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 (St. Paul, MN)
- …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 (St. Paul, MN)
- **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
- Evolent (St. Paul, MN)
- …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
- Blue KC (Workman, MN)
- …UM system in accord with UM concurrent review guidelines. Consults with Medical Director on cases outside medical policy, notifies providers and ... of our offerings include:** **Highly competitive total rewards package, including comprehensive medical , dental and vision benefits as well as a 401(k) plan that… more
- Datavant (St. Paul, MN)
- …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 (St. Paul, MN)
- …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