- Elevance Health (Woodland Hills, CA)
- …plans in California. Our group plans include a variety of group medical, pharmacy , dental, vision, life and disability plans, and are flexible enough to fit ... any size business. The **Medical Director ** is responsible for the administration of physical and/or...required by State contracts or regulations if the Medical Director is filing a role required by a State… more
- The Cigna Group (Philadelphia, PA)
- **OVERVIEW:** The Chief Pharmacy Officer (Senior Director ) oversees and directs the creation, adoption and evaluation of clinical pharmacy programs, product ... internal partner teams: + Provides oversight of clinical operations that support formulary/ UM strategies, working closely with Cigna Pharmacy project management… more
- CVS Health (Springfield, IL)
- …in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment ... in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment… more
- University of Michigan (Ann Arbor, MI)
- …professional to join the 340B team. This position reports up to the Assistant Director , Pharmacy 340B Program. This role is responsible for working with other ... Pharmacy 340B Program Analyst Apply Now **Summary** The...Um Hospital **Department** MM Contracted Pharmacies **Posting Begin/End Date** 3/25/2024 - 5/24/2024 **Career Interest** Finance Pharmacy Apply… more
- Highmark Health (Wexford, PA)
- …accordance with all regulatory agency requirements **ESSENTIAL RESPONSIBILITIES** + Reviews pharmacy utilization management ( UM ) coverage requests and prepares ... and administers the effective and efficient processing of the pharmacy benefits prior authorization process, ensuring that pharmacy...cases for clinical review by a pharmacist and/or medical director when required. (20%) + Within the context of… more
- WellSense (Boston, MA)
- Senior Director of BH Clinical Programs WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through ... Vice President of the Senior Vice President of Behavioral Health, the Senior Director of BH Clinical Programs oversees the BH Care Management, BH Utilization… more
- Baylor Scott & White Health (Temple, TX)
- …accountable to provide professional leadership and direction in the utilization/cost management ( UM ) and clinical quality improvement (QI) of the Health Plan, as ... measured by benchmarked UM and QI goals. Works collaboratively as a clinical...care performance. + Partner with Provider Networks and Medical Director team in creating and maintaining programs that incentivize… more
- YesCare Corp (Cumberland, MD)
- …Veteran status. EOE including Disability/Protected Veterans._ **Responsibilities** Regional Medical Director (RMD) is primarily accountable for quality and of ... Below is a list of your responsibilities as a **Regional Medical Director ** **(RMD)** with YesCare: **Administrative:** + Provision of comprehensive health care. +… more
- CVS Health (Columbus, OH)
- …that are evidence-based* Work collaboratively with the Behavioral Health, Pharmacy , member outreach, Care Management, National Quality Management, Utilization ... professional and effective manner.* Actively participate in State Fair Hearings as needed. Understand UM and participate in UM front line work and appeals as… more
- Molina Healthcare (Detroit, MI)
- …providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. + Develops and implements ... appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership… more
- CVS Health (Overland Park, KS)
- …five (5) years clinical experience with Geriatrics and LTSS population. + The LTSS Medical Director must live in the state of Kansas or be willing to relocate to ... Kansas and obtain a Kansas medical license. The LTSS Director will be required to spend a majority of...of holistic and integrated person-centered care. + Participate in QM/ UM monthly meetings + Be responsible for maintaining compliance… more
- Molina Healthcare (Albuquerque, NM)
- …costs. * Provide regional medical necessity reviews and cross coverage * Standardizes UM practices and quality and financial goals across all LOBs * Responds to ... **REQUIRED EXPERIENCE:** * 5 years previous experience as a Medical Director in clinical practice * 3 years' experience in Utilization/Quality Program… more
- University of Michigan (Ann Arbor, MI)
- …directly relate to this position. **Summary** Provide ambulatory clinical pharmacy services (comprehensive medication review, disease management under a ... clinic staff + Assist in the development and implementation of new ambulatory pharmacy services to support the Michigan Medicine?s goals and objectives + Assure… more
- University of Miami (Miami, FL)
- …opportunity for a Staff Pharmacist. SUMMARY Under the general supervision of the Director of Pharmacy or her/his designee the Staff Pharmacist ensures the ... all other job related duties as assigned by the Director of Pharmacy Services or her/his designee....verbal communication skills for interacting with all levels of UM Sylvester staff, Physicians, and others. #li-c1 The University… more
- Highmark Health (Columbus, OH)
- …overall efficiencies. + Manage individual projects for timely review with the Director , Clinical Pharmacy . + Participate in Medicare Stars performance measures ... dose and duration edits, quantity limits, step-care edits, generic sampling, pharmacy policy review and development and/or review of member specific information… more
- Humana (Indianapolis, IN)
- …in close coordination with other key staff. + Work closely with the Pharmacy Director to ensure compliance with pharmacy -related responsibilities. + ... and help us put health first** The RVP, Health Services (Medical Director /Chief Medical Officer) is dedicated full-time to the Contractor's Indiana Medicare &… more
- CVS Health (Buffalo Grove, IL)
- …processes, which may include supporting the development of new formulary offerings, UM programs, Healthcare Reform, Women's Health, and other clinical programs (DUR, ... applications. Responsibilities also include interfacing with other leaders (Manager/Sr. Manager/ Director ) to support product development, enterprise formulary initiatives, and… more
- University of Maryland, Baltimore (Baltimore, MD)
- …applying and interested in new leadership positions may also be considered for Director , Division of Gerontology in EPH; Director the campus-wide Center for ... in the department, across the School of Medicine and UM Campuses, and the VA is encouraged. Within the...at the University's six health professional schools (medicine, nursing, pharmacy , dentistry, social work, and law), and expand the… more
- MTC (Anson, TX)
- …services administrator, and clinically to the MTC Medical corporate medical director . Responsible for providing medical services related to diagnosis and treatment ... patient care and facility operations. 10. Comply with all applicable pharmacy regulations, especially those regarding controlled substances. 11. Provide health… more