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... coordination, documentation, and communication of medical services and/or benefit administration determinations. ... appropriate criteria to make a medical necessity determination. Complete telephonic, faxed, ... Case Management Discuss cases with..
Description The Chief Medical Officer, Group Medicare relies on the medical background to create and oversee clinical strategy for the Group Medicare business. The CMO Group Medicare, requires and in-depth understanding ..
... the BH Supervisor/ Manager or Director Required Qualifications Experience working with ... investigative skills Excellent organizational and time management skills Strong attention to ... with clear direction and as..
Description The Medical Director relies on fundamentals of CMS ... and reviewing appeals for Medicare Part C Line of Business. The ... C Line of Business. The Medical Director provides..
... Product Manager role is a part of the Pharmacy Product & ... across Medicare, Medicaid and Commercial medical and pharmacy insurance products. Although ... include nurses, pharmacists and regional..
Job Information Humana Care Team Medical Director in San Juan Puerto Rico ... Rico Description The Care Team Medical Director is responsible for improving the ... unique opportunity to be..
... and collaborate with the Retail Medical Directors, Value Based/Innovative Home Care ... Directors, Value Based/Innovative Home Care Director, Strategy Advancement Advisor, Resolution team, ... reported by the Operation team,..
... coordination, documentation, and communication of medical services and/or benefit administration determinations. ... Behavioral Health Professional 2 completes medical record reviews from medical records sent from Behavioral Health ... appropriate..
... Humana Medicare Appeals and Grievance Medical Director in San Juan Puerto Rico ... Juan Puerto Rico Description The Medical Director relies on fundamentals of CMS ... and reviewing appeals..
Description The Medical Director relies on medical background and reviews health claims. ... and reviews health claims. The Medical Director work assignments involve moderately complex ... of variable factors. Responsibilities..
... Healthy Horizons is seeking a Medical Director to help develop and execute ... develop initiatives to address women's medical and behavioral needs for adolescents, ... role requires strong collaboration..
