- Molina Healthcare (Augusta, GA)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. * Reviews… more
- Humana (Lincoln, NE)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and… more
- CareFirst (Baltimore, MD)
- …as quality initiatives, compliance, population health, and/or member/provider experience. + Analyzes Medicare and Medicaid pharmacy and medical drug ... **Resp & Qualifications** **PURPOSE:** Director , Pharmacy Services is responsible for...Medicare Advantage products. This role has oversight of pharmacy staff and develops and maintains collaborative relationships with… more
- University of Southern California (Los Angeles, CA)
- …rules and requirements for Medicare Part B DMEPOS and Medi-Cal. The Director of Pharmacy Services will also serve as the Pharmacist-In-Charge, being ... The USC School of Pharmacy is accepting applications for a Director...in high-volume (>500 prescriptions) environment 4) Experience in academic medical center outpatient pharmacy 5) Knowledge of… more
- Humana (Oklahoma City, OK)
- …a part of our caring community and help us put health first** The Director , Product Management for CenterWell Pharmacy Digital leads the strategic vision, ... development, and delivery of CenterWell Pharmacy 's website and mobile app experiences. This role is...including accelerating growth in payor agnostic markets. Additionally, the Director will lead a team of Product Owners (POs)… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Pharmacy Supply Chain Director is responsible for leading critical financial and analytic functions within the ... pharmacy data and analytics capabilities **ESSENTIAL FUNCTIONS:** + Pharmacy Supply Chain ( Pharmacy & Medical...in collaboration with the business sponsor. + Expertise in Medicare , Medicaid, and Commercial pharmacy operations. +… more
- Elevance Health (Los Angeles, CA)
- **Clinical Pharmacy Account Director - Clinical Account Management** **Location:** This role requires associates to be in-office 3 days per week, fostering ... accommodation is granted as required by law. The **Clinical Pharmacy Account Director ** is responsible for building...data and experience in supporting commercial as well as Medicare business are essential, as are strong communication and… more
- Walmart (Bentonville, AR)
- **Position Summary ** As Director , Payer Programs (Rx Clinical Services), you will lead pharmacy clinical services contracting and payer relationship development ... how patients experience healthcare. **What you'll do ** + Direct pharmacy clinical services contracting by overseeing complex negotiations, governance structures,… more
- Corewell Health (Grand Rapids, MI)
- …care management, authorizations, customer service interactions, pharmacy , Rx profiles, medical policies, and plan documents for all non- Medicare product ... + Act as lead for expedited requests, gathering relevant information, working with Medical Director to determine if criteria is met. If expedited criteria… more
- Henry Ford Health System (Traverse City, MI)
- …is required. GENERAL SUMMARY: Responsible for the retention and growth of the Medicare line of business (both Individual and Group) accounting for more than $400 ... planning and marketing support. Coordinate the development and implementation of Medicare Advantage sales strategies, compliance activities and oversight for both… more
- Penn Medicine (Philadelphia, PA)
- …each day. Are you living your life's work? Summary: + Penn Presbyterian Medical Center is seeking a full-time Clinical Pharmacy Specialist, Opioid Stewardship. ... of information technology for pharmacotherapy management.* Implement and maintain clinical pharmacy programs that support meeting Medicare Core Measures.… more
- Mount Sinai Health System (New York, NY)
- **Job Description** Under direct supervision of the Director of Specialty Pharmacy , the Specialty Pharmacy Manager and the Specialty Pharmacy Clinical ... with clinical employees on multiple levels, including pharmacists, nurses, medical /clinical staff, Finance personnel, department managers, access services staff, and… more
- Humana (Miramar, FL)
- …purchasing coordinator. + Performs other duties as assigned by direct supervisor, Sr. Pharmacy Director and/or Clinical Pharmacists **Use your skills to make an ... a part of our caring community and help us put health first** The Pharmacy Fulfillment Technician/ Care Management Support Assistant 2 works as a liaison between… more
- CenterWell (Indianapolis, IN)
- …healthcare by putting seniors at the heart of everything we do. As an **Associate Medical Director (AMD) at CenterWell Senior Primary Care,** you will be an ... such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational...**Use your skills to make an impact** **The Associate Medical Director will be responsible for all… more
- CenterWell (Las Vegas, NV)
- …the lives of our patients, and the healthcare industry as a whole. The Associate Medical Director serves as a health-care professional and capable of handling a ... variety of health-related problems. The Associate Medical Director requires a solid understanding of...**Preferred Qualifications:** + Active and unrestricted DEA license + Medicare Provider Number + Medicaid Provider Number + Minimum… more
- Penn Medicine (Philadelphia, PA)
- …information technology for pharmacotherapy management. + Implement and maintain clinical pharmacy programs that support meeting Medicare Core Measures. ... leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across… more
- Centene Corporation (Jefferson City, MO)
- …IRE and ALJ hearings, STARS metrics + Previous experience with ensuring high quality medical director training to review Medicare UM and appeals, Clinical ... plan leaders and cross functional stakeholders across the enterprise. + Provide medical leadership for all utilization management (appeals), pharmacy , case… more
- Gentiva (Milwaukee, WI)
- …Hospice and Palliative Medicine board certification and/or Hospice Medical Director Certification Board certification preferred. + Current Medicare Provider ... Transform Care through Compassionate Hospice Leadership.** We are seeking a dedicated Hospice Medical Director to join our leadership team and provide expert… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …), appeals, medical policy (development and maintenance), and quality improvement ( Medicare Stars, NCQA). The Medical Director ensures that Aspirus ... we demonstrate those values Every. Single. Day. Aspirus Health Plan is seeking a Director - Medical Director to join our team in Wausau, WI! The Medical… more
- UCLA Health (Los Angeles, CA)
- …Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Medical Director , Clinical Operations to help shape the future of our plan. ... this key leadership role, you'll work closely with the Medical Director , Department of Health Services and...to ensure high-quality, cost-effective care. + Collaborate with the Pharmacy team on safe, effective medication use; participate in… more
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