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Healthcare Management Healthcare Administration

Director of Medical Review & Appeals - Government Programs

Job in Baltimore, Anne Arundel County, Maryland, 21276, USA
Listing for: CareFirst, Inc.
Full Time position
Listed on 2026-02-01
Job specializations:
  • Healthcare
    Healthcare Management, Healthcare Administration
Salary/Wage Range or Industry Benchmark: 150000 - 200000 USD Yearly USD 150000.00 200000.00 YEAR
Job Description & How to Apply Below
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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