• Medical Director - National…

    Humana (Harrisburg, PA)
    **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
    Humana (10/25/25)
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  • Coordinator Appeals & Grievances

    AmeriHealth Caritas (Philadelphia, PA)
    …for decision making or example, internal committee/panel, independent review organization, internal medical director - as process dictates + Provide support ... impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth...needed to ensure proper handling of the appeal eg UM team, medical directors, claims, contact center,… more
    AmeriHealth Caritas (10/09/25)
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  • Clinical Reviewer, Nurse -9am -6pm PST

    Evolent (Harrisburg, PA)
    …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
    Evolent (10/21/25)
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