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16 fresh jobs found

Medical Director - Florida
Remote US

Home health services Health claims review Grievance and appeals processes Outpatient services Commercial health insurance Inpatient rehabilitation Post-acute care Clinical group practice management Hospitalist +81

Exec Senior Full Time

USD 223K+

Appeals Nurse
HGB SCA Remote KY

TRICARE policies Tricare DRG ICD-9 Medical Documentation Accreditation Peer review MCG ICD +44

USD 69K+

Reviewing Medical Director
Remote US

Grievance processes Care facilitation Post-acute services Health claims review Grievance and appeals processes Outpatient services Commercial health insurance Post-acute care Inpatient rehabilitation +93

Exec Senior Full Time

USD 199K+

Medical Director - Southeast Region
Remote US

Health claims review Post-acute services Grievance and appeals processes Outpatient services Social determinants Inpatient rehabilitation Commercial health insurance Post-acute care Coding practices +80

Exec Senior Full Time

USD 199K+

Associate, Pharmacy Policy Development
Remote

Pharmacy Policy Quality care Clinical Policy Clinical evidence Prior authorizations MCG Medical Writing Medical Coding Technology Platform +17

USD 113K+

Medical Director - Gulf South
Remote US

Health claims review Commercial health insurance Outpatient services Grievance and appeals processes Social determinants Hospitalist Clinical group practice management Clinical reference materials Inpatient rehabilitation +81

Exec Senior Full Time

USD 199K+

Medical Director - Pharmacy Appeals
Remote US

Medicare rules Commercial health insurance Clinical group practice management CMS policies Humana policies National Guidelines Rules Business Metrics Practice Management +55

Exec Senior Full Time

USD 199K+

Assistant Medical Director
WA Western Telecommuter

Premera Blue Cross

Medical policy criteria Care transition management Claims review RBRVS InterQual MCG Clinical Review Medical necessity ICD +8

Exec Senior Full Time

USD 203K+

Director, Behavioral Health (BH) & Addiction and Recovery Treatment Services (ARTS)
Work at Home - Virginia

Addiction Treatment Population Health Strategies Interdisciplinary Team Collaboration Health Plan Experience Evidence-Based Approaches CMS guidelines Cultural Competence MCG Medical Director +51

Exec Senior Full Time

USD 112K+

Manager, Pharmacy Policy
Remote

Pharmacy Policy Quality care Clinical Policy Clinical evidence MCG Medical Writing Technology Platform Prior authorization Quality improvement +23

USD 131K+

Appeals Review Nurse
Remote

NCCN Medical decision support tools Level of care reviews Medical necessity reviews Milliman care guidelines Evidence-Based Guidelines InterQual MCG Clinical Guidelines +16

Entry Mid Full Time

USD 70K+

Medical Director - Northeast Region
Remote US

Commercial health insurance Post-acute services Grievance and appeals processes Outpatient services Coding practices Clinical group practice management Judgement Inpatient rehabilitation Hospitalist +80

Exec Senior Full Time

USD 199K+

Utilization Review Nurse - Texas (Remote)
Texas, Plano, United States of America

Bracane Company

Clinical Data Collection InterQual MCG Registered Nurse Utilization management Medical terminology RN Managed Care Communication

USD 76K+

Medical Director - National Medicare Team
Remote US

Commercial health insurance Project team participation Managed Care Knowledge Clinical Standards Clinical group practice management Humana policies Medical interpretation Medical background National Guidelines +42

Exec Senior Full Time

USD 199K+

Medical Director- South Central
Remote US

Post-acute services Clinical group practice management Clinical Standards Grievance and appeals processes Outpatient services Coding practices Inpatient rehabilitation Medical background Clinical reference materials +78

Exec Senior Full Time

USD 199K+

Medical Director - Home Health - OneHome/Home Solutions
Remote US

Dynamic Environment Interpretative CMS Medicare Clinical Standards Inpatient Care Clinical reference materials Humana policies Medical interpretation CMS policies +44

Exec Senior Full Time

USD 199K+

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