- Highmark Health (Albany, NY)
- …Inc. **Job Description :** **JOB SUMMARY** This role supports the Medical Policy team by bringing medical director level expertise, experience and ... **ESSENTIAL RESPONSIBILITIES** + Full-cycle ownership of commercial and Medicare Advantage medical policy creation process including writing clinical criteria… more
- Elevance Health (New York, NY)
- …decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation. + Determine ... **Clinical Operations Medical Director ** **Carelon MBM** **Virtual:** This...which may include AIM Appropriateness Guidelines, client-specific health plan medical policy , well established evidenced based guidelines,… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and ... health, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation...communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee… more
- Humana (Albany, NY)
- **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...communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and ... health, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation...communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee… more
- Humana (Albany, NY)
- **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 operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of...communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee… more
- Humana (Albany, NY)
- **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 operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of...communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee… more
- Humana (Albany, NY)
- …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 ... to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all...communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Medical Director staff meetings, weekly case consistency meetings, monthly medical policy meetings, as well as, departmental and divisional meetings, ... you, we encourage you to apply! Job Description: The Medical Director participates in the broad array...Pharmacy Utilization Management, quality management, member care management, and medical policy processes, and support for our… more
- Humana (Albany, NY)
- **Become a part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals ... (Part D & B). The Medical director work assignments involve moderately complex...value based care in accordance with Medicare and Humana policy . All work occurs within a context of regulatory… more
Recent Jobs
-
Ecommerce Manager
- True North Goodwill (Duluth, MN)
-
Senior Engineer, Missile Manager
- RTX Corporation (Tucson, AZ)
-
Quality Engineer (Richardson)
- Zentech Manufacturing I (Richardson, TX)
-
Plant Engineer III
- PCI Pharma Services (Bedford, NH)