- Humana (Lincoln, NE)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and… more
- CVS Health (Baton Rouge, LA)
- …And we do it all with heart, each and every day. **Position Summary** The Lead Director , Pharmacy Appeals will lead a team of 40+ colleagues in the ... internal business units to resolve issues quickly. The Lead Director , Pharmacy Appeals is also...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- State of Massachusetts (Boston, MA)
- …maximize their skills and talents to serve our citizens. *_About the Role:_* The Director of Pharmacy Benefit Manager Oversight operating within the Health Care ... requested health care services. The primary purpose of the Director of Pharmacy Benefit Manager Oversight is...Benefit Managers and the processing of insured health plans' pharmacy benefit denials and appeals as overseen… more
- Henry Ford Health System (Detroit, MI)
- GENERAL SUMMARY:Under the direction of the Department Director or Manager, coordinates and facilitates operations in key department areas such as automation and ... are related to automation and associated activities. Works closely with pharmacy , nursing, and other multidisciplinary teams within each business unit. *… 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, ... PHARMACY TECHNICIAN II- CMHH at Fort Logan Print...over six treatment milieus serving civil and forensic individuals. Medical services, occupational therapy, neuropsychological-rehabilitation services, and trauma-informed care… more
- Centene Corporation (Cheyenne, WY)
- …teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing ... + Actively practices medicine **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the...complex cases and medical necessity appeals . + Participates in provider network development and new… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …Utilization Management. The role involves providing support and consultation for utilization management ( medical and pharmacy ), appeals , medical policy ... we demonstrate those values Every. Single. Day. Aspirus Health Plan is seeking a Director - Medical Director to join our team in Wausau, WI! The Medical… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- … medical and pharmacy consultants for reviewing complex cases and medical necessity appeals . Participates in provider network development and new market ... encourage you to apply! Job Description: This position assists the Chief Medical Director to direct and coordinate the medical management, quality… more
- Molina Healthcare (AZ)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. *… more
- Beth Israel Lahey Health (Westwood, MA)
- …120,000 square foot facility in Westwood, MA, provides state of the art pharmacy services to our systems patients and employees. We specialize in patient-centered ... provide the highest level of service and become the pharmacy of choice for all our patients and employees....health care providers with required prior authorization and required appeals . Manage all mail/delivery of Rx orders including addressing… more
- CVS Health (Madison, WI)
- …do it all with heart, each and every day. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout ... Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director will be a "Work from...inpatient or outpatient services, acute and post acute services, pharmacy , appeals and state fair hearings. You… more
- UCLA Health (Los Angeles, CA)
- …UCLA Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Medical Director , Clinical Operations to help shape the future of our ... plan. In this key leadership role, you'll work closely with the Medical Director , Department of Health Services and play a vital part in scaling Health Services… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review, care management and quality to determine the ... medical effectiveness of proposed treatments and approve care management...reviews, concurrent reviews of inpatient and post-acute care, and appeals . Serves as key resource for network physicians for… more
- Clark County, NV (Las Vegas, NV)
- SENIOR DEPUTY DIRECTOR PUBLIC WORKS Print (https://www.governmentjobs.com/careers/clarkcounty/jobs/newprint/5153224) Apply SENIOR DEPUTY DIRECTOR PUBLIC WORKS ... Public Works Department is seeking qualified candidates to apply for the Senior Deputy Director of Public Works position. As a member of our team, you will support… more
- Humana (Indianapolis, IN)
- …and build collaborative care models in their practices + Coordinates with the Medical Director to integrate the administration and management of behavioral and ... in this role collaborates closely with Clinical Services and the Chief Medical Officer(CMO) to integrate the day-to-day administration and strategic management of… 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
- 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 processes. ... and results, this is your opportunity to make a lasting impact. The System Director of Payer Audit provides strategic and operational leadership for all payer audit… more
- State of Colorado (Pueblo, CO)
- …the facility clinic in a fiscally minded manner. Main contact with the DYS Medical Director for consultation and collaboration on individual cases. Oversees and ... specialty care and recommendations made by providers. Collaborates directly with the DYS Medical Director and/or other providers to determine referrals to other… more
- Deschutes County (Deschutes County, OR)
- …codes, and County policies and procedures. This role reports to the CDD Director . Key Responsibilities: + Leads and advises on building safety laws and codes; ... County code goals at meetings; assesses legislation impacts. + Manages appeals and complex compliance issues; clarifies requirements and restrictions for customers.… more
- State of Colorado (CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... Defined Contribution Plan, plus 401K and 457 plans + Medical (https://dhr.colorado.gov/state-employees/state-employee-benefits/ medical -benefits) , Dental (https://dhr.colorado.gov/state-employees/state-employee-benefits/dental-insurance) , and… more