- Highmark Health (Lincoln, NE)
- …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 (Lincoln, NE)
- …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 (Lincoln, NE)
- …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
- Evolent (Lincoln, NE)
- …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
- CenterWell (Lincoln, NE)
- …Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization review of the care ... **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… more
- Humana (Lincoln, NE)
- …relationships, value-based care, quality metrics, population health, and disease or care management . The Behavioral Health Medical Director may develop ... our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations.… more
- Humana (Lincoln, NE)
- …to the Lead Medical Director - North Central Medicaid Markets. 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
- Humana (Lincoln, NE)
- … 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
- Humana (Lincoln, NE)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… more
- CVS Health (Lincoln, NE)
- …cover urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and ... services to its membership. Aetna is looking for a medical director to be part of a...be part of a centralized team that supports the Medical Management staff ensuring timely and consistent… more
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