Medical Director — Medicare Utilization

A healthcare services organization in Minnesota is seeking a Medical Director to provide medical interpretations and determinations regarding services in line with Medicare guidelines. The position entails occasional weekend work and emphasizes collaboration in a team-based environment. Ideal candidates will possess an MD or DO degree, extensive clinical...

A healthcare organization in Minnesota seeks a Medical Director to review medical necessity for inpatient services and lead clinical decision-making. The role requires an MD or DO degree, over 5 years of clinical experience, and excellent communication skills. Join a collaborative team to support innovative healthcare solutions while ensuring compliance with...

A major healthcare provider is seeking a Medical Director to conduct medical necessity reviews and ensure regulatory compliance. The ideal candidate will hold an MD or DO degree and have over 5 years of clinical experience, particularly in inpatient settings. The position offers a compensation range of $223,800 - $313,100 annually, along with competitive...

A healthcare organization in Minnesota seeks a Medical Director to oversee clinical determinations regarding patient services, ensuring compliance with regulations and clinical guidelines. The ideal candidate will possess a medical degree, extensive clinical experience, and excellent communication skills. This role includes both remote work and occasional...

A leading healthcare provider is seeking a Corporate Medical Director who will rely on their medical background to review health claims and provide medical interpretation. This remote position requires an MD or DO degree, board certification, and at least 5 years of clinical experience. Additionally, the candidate should possess strong analysis skills and...

Medicare Sales SpecialistAt CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven...

Pharmacy Program ManagerCompany: Highmark Inc.Job Summary: This job supports the VP, Pharmacy in managing the overall Pharmacy program administration associated with the respective client portfolio as well as its P&L and contract compliance. Responsibilities include leading initiatives regarding the specific business line expense trends, cost efficiency...

A leading health organization in Saint Paul is seeking a Medical Director, Primary Care to oversee clinical evaluations and ensure service compliance with health guidelines. This role requires a medical degree, extensive patient care experience, and board certification. The ideal candidate will enjoy a structured environment, providing significant input on...

A healthcare insurance company is seeking a Medical Director in Saint Paul, Minnesota to oversee service authorizations, ensure compliance with national guidelines, and collaborate with healthcare teams. Candidates must possess an MD or DO degree and at least 5 years of clinical experience. This remote position also includes occasional travel for meetings....

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 make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs within a context of regulatory compliance, and work is...