- Elevance Health (Richmond, VA)
- …Health office locations Work schedule: Monday - Friday, standard business hours.** The Medical Director Clinical Programs is responsible for designing and ... of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative...implementing clinical programs with specific medical condition focus for all lines of business enterprise… more
- CenterWell (Richmond, VA)
- …part of our caring community and help us put health first** The National Director , Clinical Pharmacy is a strategic pharmacy leader responsible for developing, ... Medical Officer. This role reports to the National Director , High Risk Patient Management. Responsibilities will include: +...(SME) and clinical liaison to the national clinical leadership (including Chief Medical Officer, Complex… more
- Prime Therapeutics (Richmond, VA)
- …our passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions -RPH/PharmD required- REMOTE **Job Description ... Medical Pharmacy clients and potential new clients. Required to serve as a Medical Pharmacy clinical resource throughout the organization and support all … more
- Humana (Richmond, VA)
- **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 (Richmond, VA)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Richmond, VA)
- … 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 (Richmond, VA)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing ... consumer experiences and a highly engaged team culture The Medical Director conducts clinical case... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify … more
- Humana (Richmond, VA)
- …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
- Elevance Health (Richmond, VA)
- …reviews within our Medicaid and Medicare programs.** The **Behavioral Health Medical Director ** is responsible for the administration of behavioral health ... of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative...an entire clinical program and/or independently performs clinical reviews. + The Medical Director… more
- Humana (Richmond, VA)
- …& Supports or LTC/SNF with 5+ years of experience preferred **Additional Information** The Medical Director conducts clinical reviews of the care received by ... caring community and help us put health first** The Medical Director 's primary responsibility is the review...an in-depth evaluation of variable factors that rely on clinical experience and knowledge of both medicine and social… more
- Humana (Richmond, VA)
- …moderate to substantial. Humana Clinical Contracting Team is looking for a medical director with utilization management process skills. This MD will provide ... community and help us put health first** The Corporate Medical Director relies on medical ...in current up to date status + Unrestricted US Medical license + 5+ years of direct clinical… more
- Elevance Health (Richmond, VA)
- …May be responsible for an entire clinical program and/or independently performs clinical reviews. + The Medical Director typically has program management ... miles of one of our Elevance Health locations.** The Medical Director is responsible for the administration...Director Associates. May be responsible for an entire clinical program. How you will make an impact: +… more
- Humana (Richmond, VA)
- …put health first** Humana Healthy Horizons in Virginia is seeking Associate Director , Care Management (Care Management Extender Leader) who will direct and implement ... in the commonwealth of Virginia. Their team will provide clinical and non- clinical support to the assessment...for the care and well-being of members. The Associate Director , Care Management (Care Management Extender Leader) requires a… more
- CenterWell (Richmond, VA)
- …in Medicare /seniors * Demonstrated ability to work collaboratively with clinical and operational leaders across a complex health care organization. * Knowledge ... a part of our caring community and help us put health first** **National** ** Director of Transitional Care and High-Risk Patient Management** The Director of… more
- Humana (Richmond, VA)
- …our caring community and help us put health first** The Associate Director , Provider Services develops and grows positive, long-term relationships with physicians, ... providers and healthcare systems in The Associate Director , Provider Services oversees a team of associates that grow positive, long-term relationships with… more
- Prime Therapeutics (Richmond, VA)
- …and drives every decision we make. **Job Posting Title** Trade Client Strategy Director - Remote **Job Description** The Trade Client Relations Director is ... responsible for the analysis, modeling and delivery of innovative pharmacy and medical rebate strategies and cost saving solutions to Prime's clients to ensure Prime… more
- Prime Therapeutics (Richmond, VA)
- …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
- Humana (Richmond, VA)
- …assigned health plan and/or specialty companies relative to Medicare /Medicaid/TRICARE/Employer Group product implementation, operations, contract compliance, and ... collaborative organization which includes Provider Service Experience, Network Optimization, Clinical Services, Value-Based contracting, HEDIS and Risk Adjustment. Reporting… more
- Highmark Health (Richmond, VA)
- …+ Manage individual projects for timely review with the Director , Clinical Pharmacy. + Participate in Medicare Stars performance measures to drive ... as an adjunct to health coaching. If acting in the capacity as a clinical pharmacist the incumbent may also review UM requests; provide consultation into the case… more