• Medical Director - Pharmacy…

    Humana (Harrisburg, PA)
    …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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  • Clinical Appeals Reviewer

    AmeriHealth Caritas (Philadelphia, PA)
    …in the evaluation of appeals + Review appeal cases and ensure the Medical Director makes timely decisions; + Review final determinations and create decision ... MS Office, including Word, Excel, and Outlook + Proficiency in utilizing Electronic Medical Records (EMRs) + Familiarity with the appeals process, preferably… more
    AmeriHealth Caritas (10/13/25)
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  • PCO Medical Director - UM - Full…

    CenterWell (Harrisburg, PA)
    **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 (Harrisburg, PA)
    …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

    Centene Corporation (Harrisburg, PA)
    …teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing ... fresh perspective on workplace flexibility. We are hiring a Medical Director for our New Jersey market....complex cases and medical necessity appeals . + Participates in provider network development and new… more
    Centene Corporation (11/14/25)
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  • Medical Director - Medicaid N.…

    Humana (Harrisburg, PA)
    **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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  • Associate Director , Field Access Manager…

    Merck (Harrisburg, PA)
    **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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