• Medical Director - Medicare…

    Humana (Nashville, TN)
    … (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
    Humana (07/23/25)
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  • Medicare Grievances and Appeals Corporate…

    Humana (Nashville, TN)
    …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
    Humana (06/18/25)
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  • Medical Director - Florida

    Humana (Nashville, TN)
    **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
    Humana (07/29/25)
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  • Medical Director - South Carolina SE…

    Humana (Nashville, TN)
    **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
    Humana (07/22/25)
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  • Medical Director - Mid West Region

    Humana (Nashville, TN)
    **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 (05/14/25)
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  • Medical Director - NorthEast Region

    Humana (Nashville, TN)
    **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...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
    Humana (07/25/25)
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  • PRN UR Coordinator

    Community Health Systems (Franklin, TN)
    …ensuring compliance with policies, regulations, and payer requirements to establish medical necessity. + Communicates with commercial payers to provide ... and effective management of utilization review processes, including denials and appeals activities. This role collaborates with payers, hospital staff, and clinical… more
    Community Health Systems (07/02/25)
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