Remote Medical Director, Medicare Grievances

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 where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses...

Become a part of our caring community and help us put health first The Medical Director relies on medical background and reviews preauthorization requests for services. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical...

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 where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses...

A leading healthcare organization is seeking a Medical Director to oversee medical necessity reviews and provide expert decisions on healthcare services. Candidates must hold an MD or DO degree and have more than 5 years of clinical experience, particularly in a Medicare-type patient environment. The role requires strong communication and analytic skills,...

Grievances & Appeals RepresentativeBecome a part of our caring community and help us put health first. Become a valued member of Humana's Internal Review Team as a Grievances & Appeals Representative, where you will play a critical role in addressing client concerns and denials. In this position, you will perform thorough reviews of clinical documentation to...

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 at the Inpatient level. All work occurs within a context of regulatory...

A health insurance company is seeking a Medical Director in Kentucky to oversee Medicare drug appeals and ensure compliance with regulatory standards. The ideal candidate will possess an MD or DO degree and 5+ years of clinical experience. Responsibilities include collaborating with clinical teams, conducting peer discussions, and participating in CMS...

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 where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses...

Become a part of our caring community and help us put health first The Medical Director, Primary Care relies on medical background and reviews health claims. The Medical Director, Primary Care work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical...

Regional Medical Scientific Senior Director Team LeadThe Regional Medical Scientific Senior Director Team Lead (RMSD TL) is a credentialed therapeutic and disease expert who owns leadership, management, and full accountability for a regional, field-based team of Regional Medical Scientific Directors (RMSD) and their prioritized deliverables. The RMSD TL...