- Humana (Salt Lake City, UT)
- …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
- Molina Healthcare (Layton, UT)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. *… more
- University of Utah Health (Salt Lake City, UT)
- …a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy , and College of Health providing education and training for over 1,250 providers ... policy-aligned documentation including but not limited to corrective actions, terminations, appeals . + Interpret and apply policies, procedures, and employment laws… more