EmploymentCrossing Jobs

Commercial Medical Director - Work At Home - USA-NV-Las Vegas

Mon, 26 Jun 2023 00:00:00 CDT

Description 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...

Medical Director - Florida Medicaid - USA-NV-Las Vegas

Thu, 23 Mar 2023 00:00:00 CDT

Job Information Humana Medical Director - Florida Medicaid in Las Vegas Nevada Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assign...

RN Case Manager - Telephonic Nurse 2 - Complex Case Management Program (Remote) - USA-NV-Las Vegas

Fri, 07 Apr 2023 00:00:00 CDT

Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding mem...

Case Manager - USA-NV-Las Vegas

Thu, 01 Dec 2022 00:00:00 CST

Case Manager The candidate will client Intake. Monitor Treatment. Collect, Review, and Maintenance of Medical Records and Bills. Draft Demand Letters. Work with Insurance Companies to Negotiate Claim...

Case Manager - USA-NV-Las Vegas

Sat, 03 Dec 2022 00:00:00 CST

Case Manager The candidate will be processing assigned claims in accordance with Firm policies and procedures. Ensuring case management software (CMS) feed is cleared daily. Completing all assigned t...

Prior Authorization RN - USA-NV-Las Vegas

Mon, 12 Dec 2022 00:00:00 CST

Description Humana is seeking a Prior Authorization RN to join the Wisconsin Medicaid Market (iCare) team. This position reviews the clinical appropriateness of prior authorization (PA) requests and ...

Medical Director - Southeast Region - USA-NV-Las Vegas

Mon, 12 Dec 2022 00:00:00 CST

Description 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 situ...

Medical Director - Central West - USA-NV-Las Vegas

Mon, 12 Dec 2022 00:00:00 CST

Medical Director - Intermountain Region - USA-NV-Las Vegas

Fri, 16 Dec 2022 00:00:00 CST

Behavioral Health Medical Director - USA-NV-Las Vegas

Fri, 23 Dec 2022 00:00:00 CST

Description The Behavioral Health Medical Director makes determinations regarding prior authorization and retrospective reviews for inpatient and outpatient services to ensure that members receive cl...

Medical Director-KY Medicaid - USA-NV-Las Vegas

Sun, 25 Dec 2022 00:00:00 CST

Description The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Directo...

Grievances and Appeals Medical Director - Nationwide - USA-NV-Las Vegas

Sat, 22 Apr 2023 00:00:00 CDT

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

Medical Director - Claims Management - USA-NV-Las Vegas

Thu, 20 Apr 2023 00:00:00 CDT

Medical Director - Behavioral Health - Tricare - USA-NV-Las Vegas

Thu, 20 Apr 2023 00:00:00 CDT

Medical Director - South Central - USA-NV-Las Vegas

Thu, 20 Apr 2023 00:00:00 CDT

Grievances and Appeals Medical Director - Weekends Required - USA-NV-Las Vegas

Thu, 20 Apr 2023 00:00:00 CDT

Behavioral Health Medical Director - Tricare - USA-NV-Las Vegas

Thu, 04 May 2023 00:00:00 CDT

Description The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately comple...

Provider Engagement Principal - USA-NV-Las Vegas

Sat, 13 May 2023 00:00:00 CDT

Description Deliver a simplified Dental Provider Experience by driving digital and technology solutions forward in a cross collaborative and influential manner Identify the solutions and structure ne...

National Medical Director Utilization Management \u2013 Quality Management - USA-NV-Las Vegas

Tue, 13 Jun 2023 00:00:00 CDT

National Medical Director Utilization Management – Quality Management *Employed*Can work remote*Growing organization*Excellent compensation package and full benefits\r\nJob Description: \r\n\r\nLeads,...

Pre-Litigation Personal Injury Attorney - USA-NV-Henderson

Wed, 28 Feb 2024 00:00:00 CST

A law firm is seeking an experienced Pre-Litigation Personal Injury Attorney to manage a caseload of pre-litigation cases, assess claims, and negotiate settlements on behalf of clients. The success...