- Elevance Health (Scottsdale, AZ)
- …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
- 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
- CenterWell (Phoenix, AZ)
- …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 (Phoenix, AZ)
- …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 (Phoenix, AZ)
- **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 (Phoenix, AZ)
- **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...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … 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)
- …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
- Elevance Health (Phoenix, AZ)
- …May be responsible for an entire clinical program and/or independently performs clinical reviews. The Medical Director typically has program management ... in partnership with blue cross blue shield plans. The Medical Director is responsible for the administration...Director Associates. May be responsible for an entire clinical program. **This position will work a hybrid model… more
- Boehringer Ingelheim (Phoenix, AZ)
- …expectations for insight generation related to scientific objectives. + In collaboration with Medical Excellence, the MSL Director and TA Sr. AD MSLs, identify ... within Medicine and across stakeholders, and support the MSL Director in accountabilities and key initiatives. + Collaborate with...- required. + 8 or more years' of relevant medical affairs experience, clinical practice, or research:… 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
- CenterWell (Phoenix, AZ)
- …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
- Banner Health (Apache Junction, 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
- Humana (Phoenix, AZ)
- …+ Leads positive performance of medication adherence, statin use, polypharmacy, and Medicare Plan Finder measures for Pharmacy by influencing both the strategy and ... + Five years of leadership experience + Eight years clinical experience in managed care or equivalent experience +...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… 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
- CenterWell (Phoenix, AZ)
- …participant and lead with the care team through daily huddles. + Helps Regional Medical Director (RMD), Physician and Center Administrator in setting a tone of ... coding specificity. + Follows policy and protocol defined by Clinical Leadership. + Meets with RMD about quality of...to write prescriptions under the authority of a collaborating physician/ medical director + This role is considered… more
- Molina Healthcare (Phoenix, AZ)
- …including: + Minimum 5 years clinical practice. + 5 years in a Medical Director role. + 4 years HMO/Managed Care experience, including Utilization and/or ... management, and care management programs. Oversees the development of the Plan's clinical practice guidelines and provides medical oversight and expertise in… more
- Humana (Phoenix, AZ)
- …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 (Phoenix, AZ)
- …+ 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
- CenterWell (Sun City, AZ)
- … medical expertise with the care team through daily huddles. + Helps Regional Medical Director and Center Administrator in setting a tone of cooperation in ... of care, health maintenance, and disease prevention. Keeps a medical history and medical records. Refers the...coding specificity. + Follows policy and protocol defined by Clinical Leadership. + Meets with RMD about quality of… more