- Humana (Trenton, NJ)
- …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 to complex issues...of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and… more
- Humana (Trenton, NJ)
- …of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The Corporate Medical ... Director works on problems of diverse scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… more
- Highmark Health (Trenton, NJ)
- …experience in managed care pharmacy + 2 years of clinical account management experience in Medicare as part of the 4 year managed care experience + 2 years of ... experience analyzing pharmaceutical cost of care data **Substitutions** + None **Preferred** + Masters of Pharmacy or Masters of Business Administration + AMCP-ASHP accredited residency in managed care pharmacy + Experience leading or participating in Pharmacy… more
- Humana (Trenton, NJ)
- …of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests for services. The ... Medical Director work assignments involve moderately complex to complex issues...and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will… more
- Humana (Trenton, NJ)
- …a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing ... home health, SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director ...dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided… more
- Humana (Trenton, NJ)
- …a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing ... home health, SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director ...dual Medicare /Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided… more
- CenterWell (Trenton, NJ)
- …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...and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will… more
- Humana (Trenton, NJ)
- …of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations ... internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to… more
- Humana (Trenton, NJ)
- …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 ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- CVS Health (Trenton, NJ)
- …health programs and services to its membership. Aetna is looking for a medical director to be part of a centralized team that supports the Medical Management staff ... to precertification, concurrent review, and appeal request. The medical director is a work-at-home position located anywhere in the...Two (2) + years of experience in managed care ( Medicare and/or Medicaid) MD or DO; Board certification in… more