• Medical Director - National…

    Humana (San Juan, PR)
    **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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  • Clinical Reviewer, Nurse -9am -6pm PST

    Evolent (San Juan, PR)
    …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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