- Humana (Phoenix, AZ)
- …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 (Phoenix, AZ)
- …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
- Centene Corporation (Phoenix, AZ)
- …teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing ... workplace flexibility. **Position Purpose:** Assist the Sr Behavioral Health Medical Director to direct and coordinate the...complex cases and medical necessity appeals . + Participates in provider network development and new… more
- Molina Healthcare (Phoenix, 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