- Humana (Phoenix, AZ)
- …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. ... The Behavioral Health Medical Director work assignments involve moderately complex...conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare… more
- The Cigna Group (Tucson, AZ)
- Pima County based - Medicare Provider Performance Enablement (PPE) Senior Analyst provides broad support to Sr. Supervisor, Sr. Manager, Director , and Other ... interaction with PPE staff as well as other Cigna Medicare departments. Position is exposed to all aspects of...internal departments, including but not limited to Health Services, Medical Economics, Sales and Coding in order to develop… more
- Prime Therapeutics (Phoenix, AZ)
- …our passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions -RPH/PharmD required- REMOTE **Job Description ... and development of Medical Pharmacy program strategy as part of the Medical Pharmacy Specialty Clinical Solutions team. Responsible for managing current … more
- Humana (Phoenix, AZ)
- … Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert ... caring community and help us put health first** The Medical Director actively uses their medical...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … more
- Humana (Phoenix, AZ)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- CVS Health (Phoenix, AZ)
- …opportunity for a Medical Director ( Medical Affairs). The Medical Affairs department provides clinical business support to the entire enterprise and ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs....is a remote based from from home role. The Medical Affairs department provides clinical business support… more
- Humana (Phoenix, AZ)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Phoenix, AZ)
- …our caring community and help us put health first** The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The ... Behavioral Health Medical Director work assignments involve moderately complex...and assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations, … more
- Humana (Phoenix, AZ)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...+ Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry… more
- Banner Health (Phoenix, AZ)
- …as part of Banner's Population Health Services Organization (PHSO), will serve as the clinical DYAD to the Executive Director of Risk Adjustment, co-leading a ... a strong knowledge and understanding of managed care operations, reimbursement models, medical protocols and criteria including Medicare criteria, and peer… more
- Dignity Health (Phoenix, AZ)
- …heart of Phoenix, Arizona, (http://phoenix.gov/visitors/index.html) St. Joseph's Hospital and Medical Center is a 571-bed, not-for-profit hospital that provides a ... proud to be a nationally recognized center for quality quaternary care, medical education and research. St. Joseph's includes the internationally renowned Barrow… more
- Brookdale Senior Living (Phoenix, AZ)
- …and monthly sales performance expectations in partnership with community operations and clinical leaders, Director (s) of District Sales, and Divisional Sales ... revenue for assigned Brookdale communities with open Sales and Marketing Director positions. Prioritizes the outperformance of budgeted sales goals and community… more
- HealthEdge Software Inc (Phoenix, AZ)
- …to solve critical needs in healthcare. This individual will report to the Chief Medical Officer of Healthedge (HE) and ensure that our clinical suite of ... them: NCQA (National Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other… more
- Banner Health (Mesa, AZ)
- …leads the Quality Department. This role elevates high reliability in clinical performance through assessment of performance, ensures prioritization of improvement ... activities, overseeing performance improvement projects and ensuring successful clinical project implementation at operating entities. This position prioritizes … more
- Cardinal Health (Phoenix, AZ)
- …team is passionate about helping oncology practices navigate the future. The Director , Managed Care is responsible for strategy and management of managed care ... responsible to implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing… more
- CenterWell (Tucson, AZ)
- …a part of our caring community and help us put health first** The ** Clinical Manager** coordinates and oversees all direct care patient services provided by ... clinical personnel. + Develops, plans, implements, analyzes, and organizes clinical operations for a specific location managed. + Conducts/delegates the… more
- Evolent Health (Phoenix, AZ)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... rationale for standard and expedited appeals. + Utilizes medical / clinical review guidelines and parameters to assure...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Prime Therapeutics (Phoenix, AZ)
- …of utilization management decisions. + On a requested basis, may function as Medical Director for select health plans or regions, assuming overall accountability ... as needed to discuss cases and problems. + Utilizes medical / clinical review guidelines and parameters to assure... Affairs. + Other duties as assigned. **Responsibilities** + Medicare Part D experience preferred. + Doctor of Medicine… more
- BAYADA Home Health Care (Tucson, AZ)
- …Services: Hospice Physician shall perform those services appropriate to the position of medical director of a hospice, which includes, but are not limited ... Documentation and Timesheets. Complete timesheets and maintain documentation on all Medical Director Services provided in accordance with Hospice's policies… more
- HonorHealth (Scottsdale, AZ)
- …and urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care ... quality results, and other metrics. Has working knowledge of all regulatory medical management requirements for Commercial, Medicare , AHCCCS, and Medicare… more