- Molina Healthcare (San Antonio, TX)
- …markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Provides behavioral health oversight ... health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric… more
- CVS Health (Hartford, CT)
- …remote based (work at home) based anywhere in the US. **Responsibilities of this Medical Director role are related to Medicare Appeals :** * Direct daily work on ... part C appeals (both provider and member /nonparticipating providers). * Provide direct support to appeal nurses...Clinical Practice or Health Care Industry * Medical License ( MD ) or (DO) * An Active state medical license… more
- Elevance Health (Mason, OH)
- **Medical Director -Dermatology Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... for employment, unless an accommodation is granted as required by law. The **Medical Director -Dermatology Appeals ** is responsible for the review of appeals … more
- Elevance Health (Indianapolis, IN)
- ** Appeals Medical Director - Indiana Medicaid** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... required by law. Alternate locations may be considered. The ** Appeals Medical Director ** is responsible for the...to increase effectiveness and quality. **Minimum Requirements:** + Requires MD or DO and Board certification approved by one… more
- Humana (Lincoln, NE)
- …Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately ... of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and support staff to provide Humana members… more
- Elevance Health (Los Angeles, CA)
- **Behavioral Health Medical** ** Director -Psychiatrist** ** Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of ... Monday - Friday. Half day Saturday rotation, once a month.** The **Medical Director ** is responsible for the administration of behavioral health medical services, to… more
- Nuvance Health (Danbury, CT)
- …review criteria during the first level review, discuss with the attending MD to obtain additional clinical information and documentation to support inpatient level ... and delivery of required patient notices (by onsite team member ). These include but are not limited to: HINNs,...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Grant Thornton (Chicago, IL)
- As the Tax Practice & Quality Managing Director , you'll identify the impact of new tax developments and the opportunities that may relate to specialty areas - ... of concepts relevant to federal or state tax enforcement, including audits, appeals , tax litigation, summonses, statutes of limitation, and penalties. + Strong… more
- Evolent (Oklahoma City, OK)
- …the culture. **What You'll Be Doing:** As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency… more
- CVS Health (Tallahassee, FL)
- … director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review, and provider appeals ... for discussions for trend discussions. Attend in-person provider and member meetings as needed. * Develop and guide the...UM and participate in UM front line work and appeals in markets as needed. * Confer directly with… more
