- CVS Health (Baton Rouge, LA)
- …and more compassionate. And we do it all with heart, each and every day. **Position Summary** The Lead Director , Pharmacy Appeals will lead a team of ... as well as guiding other internal business units to resolve issues quickly. The Lead Director , Pharmacy Appeals is also responsible for working with the… more
- Centene Corporation (Jefferson City, MO)
- …the enterprise. + Provide medical leadership for all utilization management ( appeals ), pharmacy , case management, disease management, cost containment, and ... ALJ hearings, STARS metrics + Previous experience with ensuring high quality medical director training to review Medicare UM and appeals , Clinical review quality… more
- CareFirst (Baltimore, MD)
- …including pre-service reviews, concurrent reviews of inpatient and post-acute care, and appeals . Serves as key resource for network physicians for peer-to-peer case ... Care Management Committee, Technology Assessment Committee, Delegation Oversight Committee, Pharmacy & Therapeutics Committee, and other committees and task forces… more
- CVS Health (Tallahassee, FL)
- …(Dual-Eligible Special Needs Plan / Medicare-Medicaid Plan) * Develop and lead clinical strategy and objectives for the DSNP/FIDE populations, including the ... are evidence-based. * Work collaboratively with the Behavioral Health, Pharmacy , Member Outreach, Care Management, National Quality Management, Utilization… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …involves providing support and consultation for utilization management (medical and pharmacy ), appeals , medical policy (development and maintenance), and quality ... Every. Single. Day. Aspirus Health Plan is seeking a Director - Medical Director to join our...effective, efficient, patient-centered, and equitable. Support and help to lead aspects of regulatory compliance that relate to clinical… more
- BrightSpring Health Services (Nashville, TN)
- Our Company BrightSpring Health Services Overview The Sr. Director is responsible for management of the Revenue Cycle organization and process to ensure the timely ... on all billings for the rehabilitation business unit. The Sr Director 's responsibilities include identifying reimbursement issues, ensuring that claims, denials, and… more
- Elevance Health (Washington, DC)
- **Behavioral Health Medical Director - Psychiatrist - District of Columbia (aka Washington DC) Medicaid** **Location:** This role requires associates to be in-office ... Fulltime, regular business hours. No weekends. The **Behavioral Health Medical Director ** is responsible for reviewing cases for DC Medicaid members including… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …you to apply! Job Description: This position assists the Chief Medical Director to direct and coordinate the medical management, quality improvement and ... of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies to improve quality… more
- CenterWell (Nashville, TN)
- …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
- UCLA Health (Los Angeles, CA)
- …Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Medical Director , Clinical Operations to help shape the future of our plan. In this ... key leadership role, you'll work closely with the Medical Director , Department of Health Services and play a vital part in scaling Health Services functions. Your… more
Recent Jobs
-
Grade A/B Mechanic
- Everglades Equipment Group (Belle Glade, FL)
-
Program Manager (Family Caregiver Program) 2 Year Fixed Term/Benefit Eligible
- Stanford Health Care (Palo Alto, CA)
-
VP, Operations (LCQ)
- HAECO (Lake City, FL)