• Corporate Medical Director…

    Humana (Jefferson City, MO)
    …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
    Humana (09/05/25)
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  • Medical Director - Medicare…

    Humana (Jefferson City, MO)
    …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
    Humana (10/02/25)
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  • Registered Nurse - Clinical Appeals & Denials…

    Cognizant (Jefferson City, MO)
    …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a... Medicare , Medicaid, and third-party guidelines. . Effectively document and… more
    Cognizant (10/09/25)
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