A company is looking for a Clinical Coverage Review Medical Director to support pharmacy operations and clinical review processes.
Key ResponsibilitiesReview and approve proposed pharmacist denials for outpatient medication requestsConduct coverage reviews and render determinations based on medical necessity and policy guidelinesCollaborate with clinical staff and providers to ensure accurate and timely benefit determinationsRequired QualificationsActive, unrestricted physician licenseCurrent board certification in an ABMS or AOA specialty5+ years of clinical practice experience post-residencyExperience with electronic clinical systemsAbility to participate in rotational call coverage
Clinical Coverage Review Medical Director
A company is looking for a Clinical Coverage Review Medical Director to support pharmacy operations and clinical review processes. ...
Remote Behavioral Medical Director (7+ years of clinical experience)
Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. Collaborates effectively with clinical teams, network providers, appeals team, medical ...
Clinical Research Medical Director
A company is looking for a Clinical Research Medical Director in Thoracic Oncology. ...
Medical Director Opportunity - Medicare Risk Adjustment HCC Review - Columbus, Ohio!!
ROLE: The Medical Director reviews outpatient/inpatient medical records for proper documentation relevant to Medicare Risk Adjustment reimbursement payment system. Receives, reviews, verifies, and processes requests for medical record audits, including but not limited to, inpatient hospitalizations,...
Claims Clinical Specialist – Medical Review Team
Claims Clinical Specialist – Medical Review Team. Bring your nursing knowledge and experience, and Genworth will provide the training necessary to succeed as a Medical Review Nurse. The Claims Clinical Specialist role is an excellent opportunity for a Registered Nurse seeking a career change. You wi...
Medical Director Opportunity - Medicare Risk Adjustment HCC Review - Puerto Rico!!
ROLE: The Medical Director reviews outpatient/inpatient medical records for proper documentation relevant to Medicare Risk Adjustment reimbursement payment system. Receives, reviews, verifies, and processes requests for medical record audits, including but not limited to, inpatient hospitalizations,...
Director Clinical Ex-Emergency Department (ER)
Formulates reviews and assists in the revision of policies and procedures. Interacts, coordinates and reviews activities and actions of affiliating schools and volunteers as appropriate. Your role is to be an effective leader by coaching and developing your staff, collaborating, building teams, solv...
Medical Director Opportunity - Medicare Risk Adjustment HCC Review - Puerto Rico (Option to be Florida Based)!!
ROLE: The Medical Director reviews outpatient/inpatient medical records for proper documentation relevant to Medicare Risk Adjustment reimbursement payment system. Receives, reviews, verifies, and processes requests for medical record audits, including but not limited to, inpatient hospitalizations,...
Director of Medical Affairs
A company is looking for a Director of Medical Affairs Medical Information, Training & Communications. ...
Medical Director of Physical Medicine and Rehab Needed in Florida; Leadership Skills Required
We help negotiate your salary and contract.We coordinate interviews and help with licenses.Specialized recruiters match your career preferences.Experienced support teams take care of every detail....