• Medical Director - Pharmacy…

    Humana (Lansing, MI)
    …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
    Humana (12/03/25)
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  • PCO Medical Director - UM - Full…

    CenterWell (Lansing, MI)
    **Become 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...overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their… more
    CenterWell (11/06/25)
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  • Medical Director Aetna Duals Center…

    CVS Health (Lansing, MI)
    …will perform concurrent and prior authorization reviews with peer to peer coverage of denials. * Appeals - The medical director will perform appeals in ... and in the round robin based on "same or similar specialty" needs. * Pharmacy coverage - The medical director will perform pharmacy reviews. * The … more
    CVS Health (11/13/25)
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  • Medical Director

    Molina Healthcare (MI)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (10/17/25)
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  • Medical Director - Medicaid N.…

    Humana (Lansing, MI)
    **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...overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy ), and reviews for… more
    Humana (10/25/25)
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  • Medical Director (NV)

    Molina Healthcare (Detroit, MI)
    …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
    Molina Healthcare (11/21/25)
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  • Medical Director , Behavioral Health

    Molina Healthcare (Detroit, MI)
    …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... health and chemical dependency services. Works closely with the Regional Medical Directors to standardized utilization management policies and procedures to improve… more
    Molina Healthcare (10/17/25)
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  • Associate Director , Field Access Manager…

    Merck (Lansing, MI)
    **Job Description** Associate Director , Field Access Management The Associate Director , Field Access Management serves as the leader to a team of subject-matter ... Market Access, Public Affairs, State and Government Affairs, Trade and Specialty Pharmacy Accounts while abiding by all corporate and industry policy and procedures.… more
    Merck (11/27/25)
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  • Director Payer Audit - Revenue Cycle

    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
    Henry Ford Health System (11/04/25)
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  • Member Appeal Analyst

    Corewell Health (Grand Rapids, MI)
    …+ Support the lead for expedited requests, gathering relevant information, working with Medical Director to determine if criteria is met. If expedited criteria ... systems including: claims payments, billing and enrollment, care management, medical , pharmacy and behavioral health authorizations, customer service… more
    Corewell Health (12/03/25)
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