- Humana (Frankfort, KY)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... in accordance with Medicare and Humana policy. **Please note that this Medical Director position is non-benefitted, and compensated hourly * **Use your… more
- Molina Healthcare (Lincoln, NE)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +...provider contracting experience. + Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice,… more
- CVS Health (Hartford, CT)
- …all with heart, each and every day. **Position Summary** The Divisional CFO for Medicare Part D and Medicare Supplement is responsible for the financial ... + Serve as the chief financial partner to the Medicare Part D and Medicare Supplement business...financial analysis. **Business Performance & Partnerships** + Partner with Pharmacy , Actuarial, Clinical, Network, and Trade teams to evaluate… more
- Molina Healthcare (Detroit, MI)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. * Reviews… more
- Centene Corporation (Jefferson City, MO)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical ... with regulatory, state, corporate, and accreditation requirements. + Assists the Chief Medical Director in the functioning of the physician committees including… more
- Henry Ford Health System (Troy, MI)
- …has relied heavily on external consulting support to meet urgent Part D and pharmacy analysis needs. This new Director role establishes dedicated, in-house ... competitive advantage in 2026 and beyond. Position Summary The Director , Actuarial Services - Pharmacy / Part...Health Alliance Plan (HAP), with a primary focus on Medicare Part D and broader enterprise pharmacy … more
- Elevance Health (Denver, CO)
- **Clinical Pharmacy Account Director - Clinical Account Management** **Location:** This role requires associates to be in-office 3 days per week, fostering ... accommodation is granted as required by law. The **Clinical Pharmacy Account Director ** is responsible for building...data and experience in supporting commercial as well as Medicare business are essential, as are strong communication and… more
- Walmart (Bentonville, AR)
- **Position Summary ** As Director , Payer Programs (Rx Clinical Services), you will lead pharmacy clinical services contracting and payer relationship development ... how patients experience healthcare. **What you'll do ** + Direct pharmacy clinical services contracting by overseeing complex negotiations, governance structures,… more
- AmeriHealth Caritas (Detroit, MI)
- …and authorizations, including home- and community-based programs. + Collaborate with the Medical Director and care team to develop and monitor treatment ... the Medicare LTSS Care Coordinator manages care coordination for Medicare beneficiaries with complex medical , behavioral health, Long-Term Services &… more
- Fairview Health Services (Minneapolis, MN)
- …of any Medicare or third-party payor changes that may adversely impact Fairview Pharmacy . + Monitors the Medicare website for any updates to ensure that our ... **Job Overview** Establish and maintain patient access to Fairview Pharmacy services across the system (26 Retail pharmacy...as well as mandatory government requirements for enrollment with Medicare and Medicaid (for all 50 states) to ensure… more
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