- Highmark Health (Madison, WI)
- …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... care (hospital, outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care… more
- Humana (Madison, WI)
- …reports to the Lead Medical Director .** **Other duties:** + Identify medical management operational improvements, including those within the medical ... part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home… more
- Humana (Madison, WI)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… more
- Evolent (Madison, WI)
- …accountability for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director ... Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management , you will be a key member of the...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Select Medical (Madison, WI)
- **Overview** **Critical Illness Recovery Hospital** ** Director of Case Management ** $10,000 Sign On Bonus **_Clinical license as a registered nurse or ... in social work and minimum three (3) years of medical case management or similar experience._** **Previous...doing well by doing what is right. As the Director of Case Management **,** you will… more
- Humana (Madison, WI)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... **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 … more
- Aspirus Ironwood Hospital (Wausau, WI)
- …The Medical Director is responsible for conducting day-to-day medical management and leading ongoing improvement initiatives in collaboration with the ... Every. Single. Day. Aspirus Health Plan is seeking a Director - Medical Director to...Director of Operations, Quality Improvement Specialist, and Utilization Management . The role involves providing support and consultation for… more
- Humana (Madison, WI)
- **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
- Gentiva (Milwaukee, WI)
- …Transform Care through Compassionate Hospice Leadership.** We are seeking a dedicated Hospice Medical Director to join our leadership team and provide expert ... substances. + Hospice and Palliative Medicine board certification and/or Hospice Medical Director Certification Board certification preferred. + Current Medicare… more
- Humana (Madison, WI)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more