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Medical or religious exemption will be considered contingent upon the review of appropriate documentation. Oversee market risk management, population health management (in partnership with directors of Population Health Teams), case review, outreach programs, HEDIS reporting, site visit review coordination, triage, provider orientation, credentialing, etc.
$275,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
RemoteExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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The Medical Director will participate in all aspects of claim review services including provider telephonic discussions and provider appeals. As part of the Focus Claims Review team at Optum, the Medical Director provides leadership, organization, and direction for the claims review program.
Full-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Associate Medical Director supports the peer review processes including Quality of Care and Quality of Service (grievance) issues and is responsible for representing the health plan and the state Medicaid partner at State-level Fair Hearings and performing plan-level member/provider grievance and appeals reviews.
Full-timeExpandApply NowActive JobUpdated 13 days ago - UpvoteDownvoteShare Job
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Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid. The Medical Director’s work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, and communication of decisions to internal associates.
$274,400 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation. The Clinical Operations Associate Medical Director is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers.
$293,055 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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The schedule is very flexible requiring only 4 to 8 hours per week only onsite doing chart review and clinic oversight. Job Details: We are seeking a part-time Medical Director for our plasmapheresis clinic in Madison, TN.
Part-timeExpandApply NowActive JobUpdated 30 days ago - UpvoteDownvoteShare Job
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The Medical Director, working together with a coder (DRG Integrity Specialist), will review inpatient charts to ensure the acuity and complexity of the patient's hospital stay is appropriately captured in the clinical documentation and translated into coding.
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The Medical Director is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost effective medical care is received.
Full-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Monogram’s innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum.
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In addition, you will oversee utilization review/quality assurance, directing case management. In the Medical Director role you will provide oversight for medical policy implementation.
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