- 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
- Humana (Topeka, KS)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... in accordance with Medicare and Humana policy. **Please note that this Medical Director position is non-benefitted, and compensated hourly * **Use your… 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
- 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
- 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
- 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 (Kearney, NE)
- …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
- 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
- UCLA Health (Los Angeles, CA)
- …Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Associate Medical Director to help shape the future of our plan. In this key ... leadership role, you'll work closely with the UHMAP Medical Director and play a vital part...policy that's grounded in the latest scientific research and Medicare guidelines. Your work will directly support our Health… 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
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