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Get It Recruit - Healthcare
San Antonio, TX, United States
Your role will be pivotal in ensuring regulatory compliance while leveraging diverse resources such as national clinical guidelines, CMS policies, and internal reference materials to make informed decisions.Responsibilities:Review moderately complex to complex clinical scenarios through computer-based analysis.Prioritize daily tasks, communicate de
Job Source: Get It Recruit - HealthcareOptum
San Antonio, TX, United States
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inc
Job Source: OptumOptum
San Antonio, TX, United States
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and incl
Job Source: OptumVitas Healthcare
San Antonio, TX, United States
The medical director of VITAS fulfills two primary functions, each of which is expected to consume approximately one half of the time and work effort of the position: * The medical director has overall responsibility for medical direction of the care and treatment of patients and their families rendered by the hospice care team, and shall consult a
Job Source: Vitas HealthcareCareHarmony
san antonio, tx
Description CareHarmony works comprehensively with providers to deliver value-based care management initiatives for their patients. Our team is driven by their passion for the level of care delivered; experts in assisting patients and caregivers to navigate a sometimes-fractured healthcare system and consistently prioritize a high-quality standard
Job Source: CareHarmonyICF Olson
San Antonio, TX, United States
Director of Compliance | Remote page is loaded Director of Compliance | Remote Apply locations San Antonio, TX time type Full time posted on Posted 3 Days Ago job requisition id R2401120 The Director of Compliance will be responsible for oversight of all quality assurance operations related to the ORR Call Cente
Job Source: ICF OlsonThinksoft Technologies LLC
San Antonio, TX, United States
Job Description Job Description Benefits: 401(k) 401(k) matching Competitive salary Dental insurance Health insurance Opportunity for advancement Paid time off Parental leave Relocation bonus Stock options plan Training & development Tuition assistance Vision insurance Wellness resources Position Title: Director, Nursing Med/Surg Position Type:
Job Source: Thinksoft Technologies LLCICON Plc
San Antonio, TX, United States
To apply for this job please sign in or create an account below. must be different from email address, first name and last name Keep me signed in Marketing Communication We'd love to send you information about Jobs and Services from Evenbreak by email. Yes please. I'd like to receive emails about jobs and services from Evenbreak I'd like to rece
Job Source: ICON PlcTerrell Hills, TX, United States
Remote Medical Director Central Southern Centene
Terrell Hills, TX
Mar 07, 2024
Job Description You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Centene is seeking multiple Medical Directors for this pivotal position to support multiple states for the central southern region.Position Purpose: Assist the VP of Clinical Programs to direct and coordinate the physician component of the utilization management functions for the health plan business units. Provides medical leadership for utilization management activities and medical review activities pertaining to utilization review, quality assurance, medical review of complex, and controversial or experimental medical services such as transplants utilizing the services of consultants Performs case reviews and appeals for all health plans. Assists VP of Clinical Programs in planning, establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate paymentEducation/Experience: Requires a Medical Doctor or Doctor of Osteopathy, board certified preferably in a primary care specialty (Internal Medicine, Med/Peds, Family Practice, Pediatrics or Emergency Medicine) or other specialty familiar with Medicare patients. Previous experience within a managed care organization is preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred. Experience treating or managing care for a culturally diverse population preferred. The candidate must be an actively practicing physician. More than 1 state license is preferred. License/Certifications: Board Certification through American Board Medical Specialties. Current state medical license without restrictions. Texas State Medical License, preferredPay Range: $222,900.00 - $423,400.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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Remote Medical Director Central Southern jobs in Terrell Hills, TX, United States
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