Reviewing Medical Director Jobs in West Virginia

Description The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management ..

Description The Senior Quality Improvement Professional will focus organizational efforts on improving behavioral health (BH)/Substance Use Disorder (SUD) clinical quality performance measures to achieve optimal performance and quality for the Humana ..

Job ID 21000HVGAvailable Openings 1 PURPOSE AND SCOPE: Functions as part of the hemodialysis health care team in providing safe and effective dialysis therapy for patients under the direct supervision of ..

Description The Senior Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. Makes decisions on ..

Description The Medical Director actively uses their medical background, experience, and judgement to ... conferences, and other reference sources. Medical Directors will learn Medicare and ... their daily work. Responsibilities..

Description The Medical Director relies on fundamentals of CMS ... Medicare Guidance on following and reviewing appeals for Medicare Part C ... C Line of Business. The Medical Director provides..

... the facility staff.Maintains integrity of medical records and other FMS administrative ... treatments in collaboration with the Director.Plans, coordinates and acts as the ... implementation of FMS staffing, and..

... a Clinical Manager with Fresenius Medical Care, you will ensure that ... an Area Team Lead or Director of Operations role.Our culture: We ... that sets us apart.At Fresenius..

... a Facility Administrator with Fresenius Medical Care, you will manage and ... You will collaborate with the Medical Director and the Charge Nurse regarding ... advance your career into..

Description The Director, Clinical Pharmacy Drug Evaluation and Policy Strategies oversees drug class reviews/evaluation, clinical policy strategy development, research, P&T committee oversight, and accreditation. This position will work and collaborate with ..

Job Information Humana Nationwide Medicaid Behavioral Health Quality Lead in Charleston West Virginia Description The Behavioral Health Quality Lead will report directly to the National Medicaid Quality Director, and be responsible ..

Description The Lead Behavioral Health Medical Director oversees the work of 2 ... oversees the work of 2 Medical Directors who conduct clinical case ... themselves. The Lead Behavioral Health..

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..

... coordination, documentation and communication of medical services and/or benefit administration determinations. ... other health care providers in reviewing actual and proposed medical care and services against established ... against..

Job Information Humana Director, Behavioral Health Strategy in Charleston ... Charleston West Virginia Description The Director, Behavioral Health (DBH) will ensure ... their behavioral health needs. The Director, Behavioral Health..

Description The Medical Director relies on fundamentals of CMS ... Medicare Guidance on following and reviewing appeals for Medicare Part C ... C Line of Business. The Medical Director provides..

Job Information Humana Nationwide Associate Director, Utilization Management Nursing in Charleston ... West Virginia Description The Associate Director, Utilization Management Nursing utilizes clinical ... coordination, documentation and communication of medical..

Description The Behavioral Health Medical Director makes determinations regarding prior authorization ... Humana coverage policies and determinations, medical necessity criteria, clinical reference materials, ... conferences, and other reference sources. Medical..

Description The Medical Director relies on fundamentals of CMS ... Medicare Guidance on following and reviewing appeals for Medicare Part C ... C Line of Business. The Medical Director provides..

Job Information Humana Quality Improvement Program Lead (National Medicaid Quality) in Charleston West Virginia Description Humana Healthy Horizons is seeking a Quality Improvement Program Lead who will be responsible for the ..