- Sunrise Senior Living (Charlottesville, VA)
- …part of. COMMUNITY NAME The Colonnades Job ID 2025-234942 JOB OVERVIEW The Director of Nursing is responsible for providing leadership and management to the skilled ... and implements plans of correction for concerns and issues identified by pharmacy consultants. * Reviews and develops plans of correction with interdisciplinary team… more
- Eisai, Inc (Philadelphia, PA)
- …Compliantly educate and inform Eisai field sales of access status for both medical and pharmacy benefit products. Work with various key internal stakeholders ... , and Medicaid accounts and a proven record of success in both pharmacy and medical benefit environments are preferred.Four-year college degree or higherStrong… more
- Centene Corporation (CA)
- …* Managed Care and Medi-Cal experience, preferred Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, ... implementation of performance improvement initiatives for capitated providers. * Assists Chief Medical Director in planning and establishing goals and policies… more
- Eisai, Inc (Indianapolis, IN)
- …segments ( Medicare , Medicaid, Federal, and Commercial).Experience working with medical and pharmacy benefits, coverage policies, and reimbursement.Proven ... pertinent field access/reimbursement information (eg, customer feedback, payer coverage - medical / pharmacy benefit, access to product procurement, payer updates)… more
- Commonwealth Care Alliance (Boston, MA)
- …and long term services and supports. Works closely with delegated entities, pharmacy , dental and other vendors to assure integration, oversight, and efficiency of ... and quality improvement. - Minimum five (5) years of clinical experience in medical or behavioral health care delivery Required Knowledge, Skills & Abilities: - … more
- BlueCross BlueShield of North Carolina (NC)
- **Job Description** Join our team as Director , Actuarial Services - Medicare Pricing and lead our Medicare pricing function for all Blue Cross NC Medicare ... a team of actuaries responsible for pricing, forecasting, and strategic support of Medicare Advantage, Medicare Supplement, and Part D (PDP) products. + Oversee… more
- Centene Corporation (Jefferson City, MO)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical ... with regulatory, state, corporate, and accreditation requirements. + Assists the Chief Medical Director in the functioning of the physician committees including… more
- Elevance Health (Denver, CO)
- **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
- AmeriHealth Caritas (Detroit, MI)
- …and authorizations, including home- and community-based programs. + Collaborate with the Medical Director and care team to develop and monitor treatment ... the Medicare LTSS Care Coordinator manages care coordination for Medicare beneficiaries with complex medical , behavioral health, Long-Term Services &… more
- Fairview Health Services (Minneapolis, MN)
- …of any Medicare or third-party payor changes that may adversely impact Fairview Pharmacy . + Monitors the Medicare website for any updates to ensure that our ... **Job Overview** Establish and maintain patient access to Fairview Pharmacy services across the system (26 Retail pharmacy...as well as mandatory government requirements for enrollment with Medicare and Medicaid (for all 50 states) to ensure… more
- CenterWell (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … 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
- Humana (Indianapolis, IN)
- **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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Point32Health (MA)
- …support functions for the Pharmacy and Therapeutic's committee in collaboration with the pharmacy medical director . Leads and manages the work of the ... Point32Health (https://www.point32health.org/) . **Job Summary** Under the direction of the Director , Clinical Pharmacy Operations, the Senior Manager, Clinical … more
- CVS Health (Des Moines, IA)
- …"base plan" and in the round robin based on "same or similar specialty" needs. * Pharmacy coverage - The medical director will perform pharmacy reviews. ... services to its membership. Aetna is looking for a medical director to be part of a...Two (2) + years of experience in managed care ( Medicare and/or Medicaid) MD or DO; Board certification in… 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
- CVS Health (Springfield, IL)
- …**Position Summary** CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board ... clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director ( Medical Affairs) will report into… more
- Gentiva (Madison, 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
- Molina Healthcare (Tampa, FL)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +...provider contracting experience. + Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …determine coverage under the member's benefit. + Routes cases directly to the pharmacist/ medical director for final determination, as directed. + Issues verbal ... processing and review of prior authorization requests for both pharmacy reviews and medical specialty drug reviews.... benefit coverage across all lines of business including Medicare D to determine what type of prior authorization… more
