- CVS Health (Phoenix, AZ)
- …and more compassionate. And we do it all with heart, each and every day. **Position Summary** The Lead Director , Pharmacy Appeals will lead a team of ... as well as guiding other internal business units to resolve issues quickly. The Lead Director , Pharmacy Appeals is also responsible for working with the… more
- CVS Health (Des Moines, IA)
- …perform concurrent and prior authorization reviews with peer to peer coverage of denials. * Appeals - The medical director will perform appeals in their ... robin based on "same or similar specialty" needs. * Pharmacy coverage - The medical director will...director will participate in and be able to lead daily rounds. **Required Qualifications:** Minimum 3-5 years of… more
- CVS Health (Tallahassee, FL)
- …(Dual-Eligible Special Needs Plan / Medicare-Medicaid Plan) * Develop and lead clinical strategy and objectives for the DSNP/FIDE populations, including the ... are evidence-based. * Work collaboratively with the Behavioral Health, Pharmacy , Member Outreach, Care Management, National Quality Management, Utilization… more
- Molina Healthcare (Tampa, FL)
- …NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead , the medical director , and quality improvement staff. + ... providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. + Develops and implements… more
- Humana (Indianapolis, IN)
- …to, an overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy ), and reviews for DME, genetic testing, ... adapt and the courage to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The Medical Director … more
- UCLA Health (Los Angeles, CA)
- …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 in developing and...high-quality, appropriate, and patient-centered care. What you'll do: + Lead the development, implementation, and training of medical policies.… more
- Centene Corporation (Jefferson City, MO)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Lead a team of medical directors and supervises MD's responsible for ... utilization management and appeals functions to ensure members receive medically necessary, evidence-based care aligned with bet practice promoting safety, quality… more
- Elevance Health (Metairie, LA)
- …services to drive affordability and improve member outcomes. The **Medical Director Associate- CarelonRx** supports pharmacy prior authorization reviews to ... **Medical Director Associate - CarelonRx** **Location:** This role enables...is met and we are in compliance with all Pharmacy Benefit Management regulatory requirements. **How you will make… more
- Henry Ford Health System (Detroit, MI)
- As the Director of Payer Audit - Revenue Cycle, you'll lead a high-performing, system-wide audit team and set the strategy for pre- and post-payment audit ... driving payer behavior change through data-driven insights and cross-functional collaboration. The Director will lead a centralized team of audit professionals,… more
- BrightSpring Health Services (Nashville, TN)
- Our Company BrightSpring Health Services Overview The Sr. Director is responsible for management of the Revenue Cycle organization and process to ensure the timely ... on all billings for the rehabilitation business unit. The Sr Director 's responsibilities include identifying reimbursement issues, ensuring that claims, denials, and… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …you to apply! Job Description: This position assists the Chief Medical Director to direct and coordinate the medical management, quality improvement and ... of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies to improve quality… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review, care management and quality to determine the medical ... including pre-service reviews, concurrent reviews of inpatient and post-acute care, and appeals . Serves as key resource for network physicians for peer-to-peer case… more
- Humana (Indianapolis, IN)
- …payment programs. The Chief Psychiatrist will be based in Illinois and will also lead the development of new products and services in Humana's Medicaid BH delivery ... + Oversees, monitors, and assists with the management of psychopharmacology pharmacy benefits manager (PBM) activities, including the establishment of prior… more
- Molina Healthcare (UT)
- …and review BH portions of state contracts * Assist the BH MD lead trainers in the development of enterprise-wide teaching on psychiatric diagnoses and treatment ... second level BH clinical reviews, BH peer reviews and appeals * Supports BH committees for quality compliance. *...EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in… more
- State of Colorado (Golden, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... Lead Mid-Level Provider / Nurse Practitioner - Campus...adjusts them as indicated. Responsible to oversee accuracy of pharmacy orders. Communicates pertinent and appropriate health information to… more
- State of Colorado (Denver, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... Lead Mid-Level Provider / Nurse Practitioner - Gilliam...adjusts them as indicated. Responsible to oversee accuracy of pharmacy orders. Communicates pertinent and appropriate health information to… more
- State of Colorado (Pueblo, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... House Lead - Health Care Tech III - Pueblo...potential problems. Department Standards: + Knows, utilizes, and follows: Pharmacy Formulary, treatment plans, Infection Control manual, Physician's orders,… more
- State of Colorado (Pueblo, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... Department per requirements in applicable cases. Serves as the facilities' lead decision-maker during emergency medical situations. Approve and monitor the… more
- Sanofi Group (Los Angeles, CA)
- …**About the Job** Field Reimbursement Manager, Rheumatology reports to the Director , Field Reimbursement Managers for the Rheumatology Business Unit The Field ... Rheumatology Patient Support Services and communicate and collaborate cross-functionally to lead Kevzara pull through efforts while assisting sales partners as… more
- State of Colorado (Pueblo, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... all areas, and interdisciplinary collaboration. This position is accountable to the Lead Nurse/Nurse III/Nurse II. This full time position facilitates groups, and… more