- Humana (Columbus, OH)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and… more
- VNS Health (Manhattan, NY)
- …to, Provider Relations, Claims, Medical Director , third party administrator, pharmacy benefit manager, to achieve resolution of appeals and grievances. + ... a minimum of three years' experience in a Grievance and Appeals or related area such as medical or utilization management in a Managed Care setting required +… more
- LA Care Health Plan (Los Angeles, CA)
- … medical necessity reviews. Prepares authorizations, after approval by the Medical Director . When necessary, outreaches to providers, vendors, hospitals, and ... Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job...Conducts intake/triage and appropriate classification of Clinical A&G, and Pharmacy requests and makes accurate judgment on appeal, grievance,… more
- CVS Health (Sacramento, CA)
- …**Position Summary** CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs. We need a Double Board ... clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director ( Medical Affairs) will report into… more
- Baptist Memorial (Covington, TN)
- …assistance for their prescriptions. The individual in this position supports the BSP Director , BSP Pharmacy Staff and Clinical Pharmacists to ensure that all ... patients are getting the most out of their specialty pharmacy services. The Pharmacy Technician - Specialty...in treatment + Support BSP pharmacists to manage the appeals process for patients and ensure timely communication occurs… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... the necessary co-management of our members related to their medical , behavioral health and pharmacy needs. This...+ 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons… more
- Beth Israel Lahey Health (Westwood, MA)
- …120,000 square foot facility in Westwood, MA, provides state of the art pharmacy services to our systems patients and employees. We specialize in patient-centered ... provide the highest level of service and become the pharmacy of choice for all our patients and employees....health care providers with required prior authorization and required appeals . Manage all mail/delivery of Rx orders including addressing… more
- Molina Healthcare (Phoenix, AZ)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Centene Corporation (Sacramento, CA)
- …teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing ... perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the...complex cases and medical necessity appeals . + Participates in provider network development and new… more
- Lancaster General Health (Lancaster, PA)
- **Summary** **Job Description** **POSITION SUMMARY:** The Associate Medical Director , Hospitalist Services is responsible for assisting the Medical ... The Associate director will report to LGHP Medical Director and have a reporting relationship...Evaluate the quality and effectiveness of pharmaceutical formulary chairing Pharmacy and Therapeutics committee + Act as a representative… more
- BlueCross BlueShield of North Carolina (NC)
- **Job Description** The Medical Director brings a unique set of knowledge and skills to the business of Blue Cross North Carolina and frequently serves as an ... - $212,000 **What You'll Do** **The application of a Medical Director 's knowledge and clinical skills will...Plan members + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical … more
- UCLA Health (Santa Monica, CA)
- …Authorizations Manager, Hematology/Oncology Clinical Director and Hematology/Oncology Assistant Director , the Authorizations Pharmacy Technician will work to ... medication information required to perform patient assistance. + Ability to interpret medical information required to perform second level appeals . + Ability… more
- UPMC (Moosic, PA)
- We have an exciting opportunity for a full-time Senior Medical Director to join our leadership team with UPMC Community Care! As Senior Medical Director , ... you to learn more and apply today! The Senior Medical Director provides guidance for clinical operational...of physical health HMO's where applicable, such as a pharmacy and therapeutics committee. + Assures effective and appropriate… more
- Bayer (Knoxville, TN)
- …supporting HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals . Develop ... + In depth understanding of Payer/PBM therapy approval requirements (Prior Authorization, Medical Necessity, Denial Appeals , Formulary coverage and payment for… more
- CVS Health (Oklahoma City, OK)
- …health care more personal, convenient and affordable. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 ... Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director will be a "Work from...inpatient or outpatient services, acute and post acute services, pharmacy , appeals and state fair hearings. You… more
- Amneal Pharmaceuticals (Bridgewater, NJ)
- …units for pharmacy /retail channels as well as buy and bill medical benefit segments for biosimilar brands; Coordinating with the reimbursement teams to manage ... JOB SUMMARY The Director of Patient Access & Affordability is a...developing unique patient affordability strategies and capabilities across the pharmacy and medical benefit channels; Creating solutions… more
- Molina Healthcare (Louisville, KY)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... health and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management policies and procedures to improve… more
- Daiichi Sankyo Inc. (Seattle, WA)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... areas centered around rare diseases and immune disorders. **Summary:** The Associate Director , Field Reimbursement (ADFR) is a critical front-line member of the DSI… more
- HonorHealth (Phoenix, AZ)
- …area. The comprehensive network encompasses six acute-care hospitals, an extensive medical group with primary, specialty and urgent care services, a cancer ... care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, community services and more. With… more
- VNS Health (Manhattan, NY)
- …other evaluative measures to maintain high-quality care standards. + Plans leadership and medical director meetings as stipulated by the State BH contract ... company holidays + Health insurance plan for you and your loved ones, Medical , Dental, Vision, Life and Disability + Employer-matched retirement saving funds +… more