CareFirst, Inc.
A prominent healthcare insurer is seeking a Director of Medical Review & Appeals in Baltimore. This role manages the Clinical Medical Claims Reviews and ensures compliance with regulations for government programs. Candidates must possess a Bachelor's Degree in Nursing or equivalent experience, alongside RN licensure. With over 8 years in clinical care management and strategic oversight of clinical functions, this position provides an opportunity to lead a high-performing team while ensuring member satisfaction and regulatory compliance. The role operates on a hybrid model, allowing for flexibility between remote and office work.
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