- Humana (Lincoln, NE)
- …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
- 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
- CVS Health (Springfield, IL)
- …**Position Summary** CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board ... clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director ( Medical Affairs) will report into… more
- CenterWell (Boston, MA)
- **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
- CVS Health (Des Moines, IA)
- …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
- Centene Corporation (Salem, OR)
- …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're Hiring: Full time Medical Director for Trillium Community Health Plan,...complex cases and medical necessity appeals . + Participates in provider network development and new… more
- Molina Healthcare (Tampa, FL)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- CVS Health (Tallahassee, FL)
- …resistant illnesses through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical ... are evidence-based. * Work collaboratively with the Behavioral Health, Pharmacy , Member Outreach, Care Management, National Quality Management, Utilization...coverage review, member appeals clinical review, medical claim review, and… more
- Humana (Indianapolis, IN)
- **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
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