- Highmark Health (Jefferson City, MO)
- …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... care (hospital, outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care… more
- Humana (Jefferson City, MO)
- …reports to the Lead Medical Director .** **Other duties:** + Identify medical management operational improvements, including those within the medical ... part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home… more
- Humana (Jefferson City, MO)
- …reports to the Lead Medical Director . **Other duties:** + Identify medical management operational improvements, including those within the medical ... part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home… more
- Elevance Health (St. Louis, MO)
- …Accounts Medical Director ** is responsible for serving as the Operational Medical Director for our care management models for our National Account ... we serve. The medical director supports product strategy/design through medical management that impact health care quality, cost, and outcomes, and… more
- Centene Corporation (Jefferson City, MO)
- …the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. + ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a...performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals… more
- Centene Corporation (Jefferson City, MO)
- …the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. + ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a...state, corporate, and accreditation requirements. + Assists the Chief Medical Director in the functioning of the… more
- Evolent (Jefferson City, MO)
- …accountability for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director ... Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management , you will be a key member of the...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Select Medical (Ozark, MO)
- **Overview** **Hospital Name: CoxHealth Rehabilitation Hospital** **Partnership with Select Medical ** **Position: Director of Case Management ** **Location: ... management criteria, and implementation of safe and appropriate discharge plans. The Director of Case management is also responsible for maintaining a patient… more
- Bayer (St. Louis, MO)
- …within their Franchise Field Medical organization. Along with the TA VP, Medical Director (s), and other stakeholders, they lead development of field ... make a real difference, there's only one choice.** **Senior Director , Field Medical (Pipeline)** The Senior ...science related field (PharmD, PhD, MD, MSN); + Proven management experience of Field Medical professionals; +… more
- Humana (Jefferson City, MO)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... **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 … more