• Medical Director - Pharmacy…

    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
    Humana (12/03/25)
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  • Medical Director (Medicare)

    Molina Healthcare (Omaha, NE)
    …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 (01/07/26)
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  • Medical Director - Medicaid…

    CVS Health (Lincoln, NE)
    …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
    CVS Health (12/19/25)
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  • Director of Home Health Authorizations,…

    CenterWell (Lincoln, NE)
    …a part of our caring community and help us put health first** A ** Director of Authorizations & Eligibility** is a senior revenue cycle leader responsible for the ... payer approvals to protect revenue integrity and patient access. The Director partners closely with clinical leadership, operations, finance, compliance, and IT,… more
    CenterWell (01/08/26)
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