- Humana (Indianapolis, IN)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other ... experience in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health...to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The… more
- Humana (Lincoln, NE)
- …health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments ... Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid , or Commercial health insurance +… more
- Walmart (Bentonville, AR)
- …negotiations, including medical benefit, physician, and value-based care agreements across Medicaid , Medicare , Commercial, and Exchange lines of business. + ... **Position Summary ** As Director , Payer Programs (Rx Clinical Services), you will..., Payer Programs (Rx Clinical Services), you will lead pharmacy clinical services contracting and payer relationship development to… more
- AmeriHealth Caritas (Detroit, MI)
- …psychosocial needs. This role ensures that care is delivered by Centers for Medicare & Medicaid Services (CMS), state, and organizational guidelines, within the ... individuals with chronic conditions or disabilities. + Strong understanding of Medicare - Medicaid Plan Long-Term Services and Supports (MMP LTSS) programs.… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and ... managed care benefit plans and strong knowledge of government program contracts ( Medicare and Medicaid ) and benefits, preferred. + Strong written and… more
- Point32Health (MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the direction of the Director , Clinical Pharmacy Operations, the Senior Manager, Clinical ... Pharmacy and Therapeutic's committee in collaboration with the pharmacy medical director . Leads and manages the...Experience with multiple lines of business such as commercial, Medicare and Medicaid are desirable. Expertise in… more
- Marshfield Clinic (Marshfield, WI)
- …of the SHP pharmacy benefits. This individual works closely with the Pharmacy Director , Clinical Pharmacy Specialist, and Operations Manager to provide ... have been or be excluded from participation in any federally funded program, including Medicare and Medicaid . This is a condition of employment. Employee must… more
- Mount Sinai Health System (New York, NY)
- **Job Description** Under direct supervision of the Director of Specialty Pharmacy , the Specialty Pharmacy Manager and the Specialty Pharmacy Clinical ... procurement of financial assistance for patients with government-sponsored health plans including Medicare , Medicaid and TriCare. Preferred: 3 years of health… more
- CenterWell (Boston, MA)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other ... community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews...and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will… more
- Prime Therapeutics (Providence, RI)
- …the future of pharmacy with us. **Job Posting Title** Clinical Account Director - Remote **Job Description** The Clinical Account Director is responsible for ... all provider and member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations to… more