- Health Care Service Corporation (Albuquerque, NM)
- …development. **Job Summary** This Position Is Responsible For Assigned Aspects Of Medical Policies And Programs. Performs Medical Appeal Reviews And Interacts ... Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or the Advisory Board of… more
- Humana (Santa Fe, NM)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director ...includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above… more
- CVS Health (Santa Fe, NM)
- …And we do it all with heart, each and every day. **Position Summary** The Lead Director , Pharmacy Appeals will lead a team of 40+ colleagues in the management of ... as guiding other internal business units to resolve issues quickly. The Lead Director , Pharmacy Appeals is also responsible for working with the Presidential… more
- Humana (Santa Fe, NM)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... of service should be authorized at the Initial and Appeals /Disputes level. All work occurs within a context of...to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of… more
- Humana (Santa Fe, NM)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Santa Fe, NM)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Evolent (Santa Fe, NM)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Santa Fe, NM)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Santa Fe, NM)
- …mission. Stay for the culture. **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Santa Fe, NM)
- …per inter-rater reliability process. + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall ... appeals . + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in...utilization management while working in conjunction with the Senior Medical Director . May assist the Senior … more
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