- 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 ... requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and… more
- CVS Health (Baton Rouge, LA)
- …And we do it all with heart, each and every day. **Position Summary** The Lead Director , Pharmacy Appeals will lead a team of 40+ colleagues in the ... internal business units to resolve issues quickly. The Lead Director , Pharmacy Appeals is also...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- Centene Corporation (Jefferson City, MO)
- …hearings, STARS metrics + Previous experience with ensuring high quality medical director training to review Medicare UM and appeals , Clinical review quality ... Provide medical leadership for all utilization management ( appeals ), pharmacy , case management, disease management, cost... pharmacy consultants for reviewing complex cases and medical necessity appeals . + Participate in provider… more
- Centene Corporation (Austin, TX)
- …teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing ... perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the...complex cases and medical necessity appeals . + Participates in provider network development and new… more
- State of Massachusetts (Boston, MA)
- …maximize their skills and talents to serve our citizens. *_About the Role:_* The Director of Pharmacy Benefit Manager Oversight operating within the Health Care ... requested health care services. The primary purpose of the Director of Pharmacy Benefit Manager Oversight is...Benefit Managers and the processing of insured health plans' pharmacy benefit denials and appeals as overseen… more
- Henry Ford Health System (Detroit, MI)
- GENERAL SUMMARY: Under the direction of the Department Director or Manager, coordinates and facilitates operations in key department areas related to patient access ... for infusion authorizations. Works closely with pharmacy , nursing, and other multidisciplinary teams within each business unit. * This role supports patients'… more
- Centene Corporation (Baton Rouge, LA)
- …teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing ... perspective on workplace flexibility. **We're Hiring: Full-time Behavioral Health Medical Director ** Centene Corporation is a leading...complex cases and medical necessity appeals . + Participates in provider network development and new… more
- Centene Corporation (Salem, OR)
- …teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing ... fresh perspective on workplace flexibility. **We're Hiring: Full time Medical Director for Trillium Community Health Plan,...complex cases and medical necessity appeals . + Participates in provider network development and new… more
- CVS Health (Tallahassee, FL)
- …resistant illnesses through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical ... are evidence-based. * Work collaboratively with the Behavioral Health, Pharmacy , Member Outreach, Care Management, National Quality Management, Utilization...coverage review, member appeals clinical review, medical claim review, and… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …Utilization Management. The role involves providing support and consultation for utilization management ( medical and pharmacy ), appeals , medical policy ... 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
- Henry Ford Health System (Troy, MI)
- …Management Senior Director Medicare Stars, HEDIS, and Reporting HAP Medical Directors Vice Presidents within Pharmacy , Strategic Development, Provider ... The HAP Medical Director represents the plan and...contracted providers when necessary + Review member and provider appeals of medical necessity denials to ensure… more
- Beth Israel Lahey Health (Westwood, MA)
- …120,000 square foot facility in Westwood, MA, provides state of the art pharmacy services to our systems patients and employees. We specialize in patient-centered ... provide the highest level of service and become the pharmacy of choice for all our patients and employees....health care providers with required prior authorization and required appeals . Manage all mail/delivery of Rx orders including addressing… more
- Elevance Health (Washington, DC)
- **Behavioral Health Medical Director - Psychiatrist - District of Columbia (aka Washington DC) Medicaid** **Location:** This role requires associates to be ... required. Schedule: Fulltime, regular business hours. No weekends. The **Behavioral Health Medical Director ** is responsible for reviewing cases for DC Medicaid… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- … medical and pharmacy consultants for reviewing complex cases and medical necessity appeals . Participates in provider network development and new market ... encourage you to apply! Job Description: This position assists the Chief Medical Director to direct and coordinate the medical management, quality… more
- Molina Healthcare (Augusta, GA)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. *… more
- CVS Health (Madison, WI)
- …do it all with heart, each and every day. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout ... Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director will be a "Work from...inpatient or outpatient services, acute and post acute services, pharmacy , appeals and state fair hearings. You… more
- UCLA Health (Los Angeles, CA)
- …UCLA Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Medical Director , Clinical Operations to help shape the future of our ... plan. In this key leadership role, you'll work closely with the Medical Director , Department of Health Services and play a vital part in scaling Health Services… more
- Centene Corporation (Raleigh, NC)
- … medical and pharmacy consultants for reviewing complex cases and medical necessity appeals . Participates in provider network development and new market ... benefits including a fresh perspective on workplace flexibility. **We're Hiring: Full time Medical Director in North Carolina.** Centene Corporation is a leading… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review, care management and quality to determine the ... medical effectiveness of proposed treatments and approve care management...reviews, concurrent reviews of inpatient and post-acute care, and appeals . Serves as key resource for network physicians for… more
- Humana (Indianapolis, IN)
- …and build collaborative care models in their practices + Coordinates with the Medical Director to integrate the administration and management of behavioral and ... in this role collaborates closely with Clinical Services and the Chief Medical Officer(CMO) to integrate the day-to-day administration and strategic management of… more