- Humana (Columbus, OH)
- **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...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- CenterWell (Columbus, OH)
- **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 ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference… more
- Molina Healthcare (Cleveland, OH)
- …+ Identifies quality-of-care, safety, and compliance concerns and escalate to the Medical Director as appropriate. + Maintains compliance with federal, state, ... criteria (eg, ASAM, MCG, InterQual). + Computer proficiency and experience with electronic medical record or UM systems. To all current Molina employees: If… more
- Molina Healthcare (Dayton, OH)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Elevance Health (Mason, OH)
- ** Medical Director -PSCCR** Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... an accommodation is granted as required by law. The ** Medical Director -PSCCR** is responsible for the administration...player, collaborative, and capable of independent work. + Prior UM review experience. For candidates working in person or… more
- CVS Health (Columbus, OH)
- … medical license without encumbrances in one of these states.** + In the Medical Director role you will provide oversight for medical policy ... Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...consistent responses to members and providers. + As a Medical Director you will focus primarily on… more
- Molina Healthcare (Columbus, OH)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- Evolent (Columbus, OH)
- …Tasks are performed within the RN/LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, ... that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers.... + Appropriately identifies and refers quality issues to UM Leadership. + Appropriately identifies potential cases for Care… more
- Trinity Health (Columbus, OH)
- …management database of referrals and treatment plans for Members. + Coordinates with Medical Director /Associate Medical Directors on case-specific issues. + ... Manager MCHP is responsible for the coordination of the medical care provided to Plan members with Plan providers,...implementation of Case Management software along with the Plan's UM and QM Program and the review of the… more
- Humana (Columbus, OH)
- …the Regional Vice President of Health Services (RVP) and Health Services Director (HSD). This position focuses on enabling connections with providers, supporting ... for provider partners regarding utilization management operations questions, interfacing with central UM team. + Collaborate with the delegation team to identify and… more