- Humana (Denver, CO)
- …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
- Bayer (Denver, CO)
- …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
- State of Colorado (Denver, CO)
- …the facility clinic in a fiscally minded manner. Main contact with the DYS Medical Director for consultation and collaboration on individual cases. Oversee the ... specialty care and recommendations made by providers. Collaborates directly with the DYS Medical Director and/or other providers to determine referrals to other… more