- Humana (Phoenix, AZ)
- …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. ... The Behavioral Health Medical Director work assignments involve moderately complex...conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare… more
- CVS Health (Phoenix, AZ)
- …based (work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part ... of experience in a Health Care Delivery System eg, Clinical Practice or Health Care Industry * Medical...Board Certified in ABMS Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance &… more
- CVS Health (Phoenix, AZ)
- …implementation of large product initiatives, including new products and product enhancements for Medicare formularies, UM and clinical tools for Medicare ... the formulation, implementation and milestone tracking for business plans as Part of the Medicare benefit and product cycle. Directs the strategic development and… more
- Prime Therapeutics (Phoenix, AZ)
- …our passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions -RPH/PharmD required- REMOTE **Job Description ... and development of Medical Pharmacy program strategy as part of the Medical Pharmacy Specialty Clinical Solutions team. Responsible for managing current … more
- Humana (Phoenix, AZ)
- **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Phoenix, AZ)
- … Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert ... caring community and help us put health first** The Medical Director actively uses their medical...reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and … more
- Humana (Phoenix, AZ)
- **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
- CVS Health (Phoenix, AZ)
- …opportunity for a Medical Director ( Medical Affairs). The Medical Affairs department provides clinical business support to the entire enterprise and ... Fortune 4 company, has an outstanding opportunity for a Medical Director - Medical Affairs....need a Board Certified Oncologist for this opportunity. The Medical Affairs department provides clinical business support… more
- Humana (Phoenix, AZ)
- **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 (Phoenix, AZ)
- …our caring community and help us put health first** The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The ... Behavioral Health Medical Director work assignments involve moderately complex...and assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations, … more
- Humana (Phoenix, AZ)
- …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...+ Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry… more
- Banner Health (Phoenix, AZ)
- …as part of Banner's Population Health Services Organization (PHSO), will serve as the clinical DYAD to the Executive Director of Risk Adjustment, co-leading a ... a strong knowledge and understanding of managed care operations, reimbursement models, medical protocols and criteria including Medicare criteria, and peer… more
- Dignity Health (Phoenix, AZ)
- …heart of Phoenix, Arizona, (http://phoenix.gov/visitors/index.html) St. Joseph's Hospital and Medical Center is a 571-bed, not-for-profit hospital that provides a ... proud to be a nationally recognized center for quality quaternary care, medical education and research. St. Joseph's includes the internationally renowned Barrow… more
- HealthEdge Software Inc (Phoenix, AZ)
- …to solve critical needs in healthcare. This individual will report to the Chief Medical Officer of Healthedge (HE) and ensure that our clinical suite of ... them: NCQA (National Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other… more
- Cardinal Health (Phoenix, AZ)
- …team is passionate about helping oncology practices navigate the future. The Director , Managed Care is responsible for strategy and management of managed care ... responsible to implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing… more
- Humana (Phoenix, AZ)
- …hospice organizations. + Manage incoming leads as assigned + Collaborate with Clinical Sales Specialist for lead development through transition to implementation + ... 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
- Prime Therapeutics (Phoenix, AZ)
- …of utilization management decisions. + On a requested basis, may function as Medical Director for select health plans or regions, assuming overall accountability ... as needed to discuss cases and problems. + Utilizes medical / clinical review guidelines and parameters to assure... Affairs. + Other duties as assigned. **Responsibilities** + Medicare Part D experience preferred. + Doctor of Medicine… more
- HonorHealth (Scottsdale, AZ)
- …and urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care ... quality results, and other metrics. Has working knowledge of all regulatory medical management requirements for Commercial, Medicare , AHCCCS, and Medicare… more
- Aveanna (Phoenix, AZ)
- …work and documentation with accuracy and within Premier time frames Assists the Clinical Director with maintaining compliance as directed Actively listens and ... Operations Specialist - Medical Records & Payroll ApplyRefer a FriendBack Job...and external clients as it relates to branch location's clinical operational support activities. Compensation:$21/HR, plus monthly incentive potential… more
- Conviva (Phoenix, AZ)
- …years experience in medical coding collaboration with healthcare providers + Medical record review knowledge + Medicare Risk Adjustment knowledge + Extensive ... put health first** This role is embedded within the clinical education team and will work also closely with...CenterWell Primary Care Organization. This role reports to Associate Director of coding education and has a dotted line… more