- Humana (Phoenix, AZ)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director reviews cases of diverse scope ... and complexity ranging from moderate to substantial. The Corporate Medical Director reviews medical necessity...This is a remote position reporting to Grievance and Appeals Director or MD Team Lead **Scheduled… 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 ... materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of… more
- CVS Health (Phoenix, AZ)
- …assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ( Medicare /Medicaid) programs and ... Fortune 4 company, has an outstanding opportunity for a Medical Director - Medical Affairs....medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ( Medicare /Medicaid) programs… 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)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… 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
- Centene Corporation (Phoenix, AZ)
- …problems or issues. May consult with Clinical Pharmacists or Regional Medical Director on related issues. + Prior Authorization Medicare Part D and Part ... the following areas: Formulary Management, Pharmacy Audit and Recovery, Pharmacy Service Center, Medicare Part D/Part B, Appeals , Medicare Part D Operations… 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 ... member of the utilization management team, and provides timely medical review of service requests that do not initially...fax. + Provides clinical rationale for standard and expedited appeals . + Provides assistance and act as a resource… more