- Merck & Co. (North Wales, PA)
- Job DescriptionThe Executive Director , Patient Access COE (ED) will lead a cross-functional team responsible for managing and developing US Patient Access Hub and ... COE, working closely with senior leaders in Sales, Marketing, Legal, Compliance, Medical Affairs, and Finance to integrate patient access initiatives seamlessly into… more
- Humana (Trenton, NJ)
- …or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical ... caring community and help us put health first** The Medical Director relies on medical ...or Surgery specialties + Utilization management experience in a medical management review organization, such as Medicare … more
- Humana (Trenton, NJ)
- …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...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Trenton, NJ)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify … more
- Humana (Trenton, NJ)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... of the Medicare rules, Humana policies and medical necessity. The Medical Director ...diverse resources, included but not limited to CMS policies, National and Local Coverage Determinations, CMS-recognized Compendia, NCCN, Humana… more
- Humana (Trenton, NJ)
- **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 (Trenton, NJ)
- **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 (Trenton, NJ)
- **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
- Evolent Health (Trenton, NJ)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you will be a key member of ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- CVS Health (Blue Bell, PA)
- …convenient and affordable. **Position Summary** Aetna is recruiting for a Lead Director , National VBS Development who will develop innovative and strategic ... provider relationships as part of the National VBS Business Development team. You will work collaboratively across the Network organization to ensure speed to market… more
- Humana (Trenton, NJ)
- …caring community and help us put health first** The Associate Director , Actuarial Analytics/Forecasting analyzes and forecasts financial, economic, and other data ... medium and long-term financial and competitive position. The Associate Director , Actuarial Analytics/Forecasting requires a solid understanding of how organization… more
- Humana (Trenton, NJ)
- …our caring community and help us put health first** Humana's seeking a Director of Corporate Communications that is experienced in civic engagement to join working ... remote anywhere in the US. As the Director of Corporate Communications, Civic Engagement, you will serve...for various platforms, including social media, thought leadership, and national partnerships + Build and maintain relationships with media… more
- Humana (Trenton, NJ)
- …our caring community and help us put health first** The Associate Director , Cloud Architecture designs, builds, and maintains data processing architectures and ... and unstructured data to insights at enterprise scale. The Associate Director , Cloud Architecture requires an in-depth understanding of how organization capabilities… more
- CVS Health (Trenton, NJ)
- …to make health care more personal, convenient and affordable. **Lead Sales Director , Growth, CVS Accountable Care** This is a remote opportunity and qualified ... providers and payers in successfully delivering on value-based care programs. The Lead Director , Growth, CVS Accountable Care is a key member of the team with… more
- Penn Medicine (Bala Cynwyd, PA)
- …leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across ... Hospice- 150 Monument Road** **Hours: Per Departmental Needs** Summary: + The Director , Penn Partners in Care (PPiC) skillfully and strategically leads care… more
- Prime Therapeutics (Trenton, NJ)
- …legislative/oversight bodies (eg, URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQA- National Committee for ... passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description Summary**… more
- Bayer (Philadelphia, PA)
- …minds to make a real difference, there's only one choice.** **Associate Director - Field Reimbursement - Oncology Philadelphia Territory** **Associate Director ... HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals. Develop collaborative working… more
- Conviva (Trenton, NJ)
- …of our caring community and help us put health first** The Associate Director , Security Architecture will play a key role in implementing security architecture, ... ensure the enterprise can achieve the enterprise security strategy. The Associate Director , Security Architecture will play a key role in implementing security… more
- Merck (North Wales, PA)
- **Job Description** The Executive Director , Patient Access COE (ED) will lead a cross-functional team responsible for managing and developing US Patient Access Hub ... COE, working closely with senior leaders in Sales, Marketing, Legal, Compliance, Medical Affairs, and Finance to integrate patient access initiatives seamlessly into… more
- Humana (Trenton, NJ)
- …health first** Humana's Marketing organization is seeking a dynamic and experienced Director , Campaign Planning & Orchestration Leader to join our team. This leader ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
