- CVS Health (Phoenix, AZ)
- …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
- CVS Health (Des Moines, IA)
- …perform concurrent and prior authorization reviews with peer to peer coverage of denials. * Appeals - The medical director will perform appeals in their ... robin based on "same or similar specialty" needs. * Pharmacy coverage - The medical director will...director will participate in and be able to lead daily rounds. **Required Qualifications:** Minimum 3-5 years of… 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
- Molina Healthcare (Tampa, FL)
- …NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead , the medical director , and quality improvement staff. + ... providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. + Develops and implements… more
- Humana (Indianapolis, IN)
- …to, an overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy ), and reviews for DME, genetic testing, ... adapt and the courage to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The Medical Director … more
- UCLA Health (Los Angeles, CA)
- …Medicare Advantage Plan is looking for a dedicated and forward-thinking Associate Medical Director to help shape the future of our plan. In this key leadership ... role, you'll work closely with the UHMAP Medical Director and play a vital part in developing and...high-quality, appropriate, and patient-centered care. What you'll do: + Lead the development, implementation, and training of medical policies.… more
- Elevance Health (Metairie, LA)
- …services to drive affordability and improve member outcomes. The **Medical Director Associate- CarelonRx** supports pharmacy prior authorization reviews to ... **Medical Director Associate - CarelonRx** **Location:** This role enables...is met and we are in compliance with all Pharmacy Benefit Management regulatory requirements. **How you will make… more
- Centene Corporation (Jefferson City, MO)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Lead a team of medical directors and supervises MD's responsible for ... utilization management and appeals functions to ensure members receive medically necessary, evidence-based care aligned with bet practice promoting safety, quality… more
- 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 ... driving payer behavior change through data-driven insights and cross-functional collaboration. The Director will lead a centralized team of audit professionals,… 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