- Highmark Health (Austin, TX)
- …responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using ... Medical Policy criteria sets to evaluate the ... necessity and appropriateness of the requested treatment of service . Depending on the nature of the case, telephonic… more
- Elevance Health (Grand Prairie, TX)
- …our care management models for our National Account clients. The medical director will be responsible for supporting the clinical vision and implementation ... the health improvement tools offered to clients/ members. The medical director provides clinical expertise...clinical relevance to account reporting regarding use of medical services by members. Involved in identifying… more
- Humana (Austin, TX)
- …and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... Humana policies, clinical standards, and (in some cases) contracts. The Medical Director provides medical interpretation and decisions about the… more
- Molina Healthcare (Houston, TX)
- …Board Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... case management programs for mental health and chemical dependency services . Works closely with the Regional Medical ...* Supports BH committees for quality compliance. * Implements clinical practice guidelines and medical necessity review… more
- CVS Health (TX)
- …First Level Appeals / Special Projects and Committee participation when needed. The Medical Director will provide clinical , coding, and reimbursement ... of medical management programs through participation in clinical team activities. The Medical Director...providers and facilities to support the effective execution of medical services programs by the clinical… more
- Molina Healthcare (Austin, TX)
- …NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. ... and procedures that guide and support the provisions of medical staff services . Maintains a working knowledge...experience, including: + 2 years previous experience as a Medical Director in a clinical … more
- HCA Healthcare (Dallas, TX)
- …and assessments in collaboration with both hospital Case Management and the Rehab Medical Director . The Clinical Rehabilitation Specialist works closely with ... from rehab services . + Performs on-site and off-site clinical evaluation to assist Rehab Medical Director in determining appropriateness of patient for… more
- CenterWell (Fort Worth, TX)
- …our caring community and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our primary care team, ... , financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and...Operations Director and/or Market President) and Shared Services partners to align on clinical and… more
- CenterWell (Arlington, TX)
- …our caring community and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our primary care team, ... , financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and...Operations Director and/or Market President) and Shared Services partners to align on clinical and… more
- Texas A&M University System (College Station, TX)
- …CPR, AED, Bloodborne Pathogens, licensure requirements, etc.). + Works closely with Medical Oversight/ Clinical Program Director to ensure abnormal research ... environment. The Research Nurse Coordinator/Manager, operating under the direction of the Clinical Program Director , is responsible for the planning, organizing,… more