- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The ... Corporate Medical Director works on problems of diverse scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… more
- Elevance Health (Woburn, MA)
- ** Director of Medicare Risk Adjustment Analytics and Reporting** **Location:** Alternate locations may be considered. This position will work a hybrid model ... will live within 50 miles of our Elevance Health PulsePoint locations. The ** Director of Medicare Risk Adjustment Analytics and Reporting** is responsible for… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Scientist supports analytic activities associated with BCBSMA overall performance on Medicare Stars ratings, with specific focus on CAHPS patient experience ... to help identify the most efficient means through which Medicare Stars clinical quality and patient experience performances at...into a cohesive view. Under direction of the Senior Director of Population Health Analytics, the Data Scientist will… more
- CVS Health (Boston, MA)
- …and affordable. **Position Summary** As the Manager, FP&A, you will report directly to Director of Finance and will monitor the end to end profit & loss statements, ... data submission for the purpose of rate setting and medical trend analysis on behalf of the Health Plan....nature of this remote role, candidates must have some Medicare and/or Medicaid experience. **Required Qualifications** -5 or more… more
- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… more
- Humana (Boston, MA)
- **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Boston, MA)
- …determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Director will learn National LTSS State ... **Become a part of our caring community and help us put health first** The Medical Director 's primary responsibility is the review of medical authorizations… more
- Evolent (Boston, MA)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Boston, MA)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director you will be a key member of the utilization management team. ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- CVS Health (Boston, MA)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...and consistent responses to members and providers. As a Medical Director you will focus primarily on… more
- Evolent (Boston, MA)
- …$64M of savings for Medicare in the Shared Savings Program. The Managing Director will report to the SVP Primary Care / President of Evolent Care Partners and ... Medicare and Commercial contracts, including plans related to medical expense management, quality improvement, appropriate risk adjustment, and patient and… more
- Tufts Medicine (Boston, MA)
- …support to the Associate CMO for Graduate Medical Education, TM Entity Medical Education Physician Leaders and the Director of Simulation, as needed. This ... Education (OCE) at Tufts Medicine oversees the following components: Graduate Medical Education, Undergraduate Medical Education, Physician Assistant Education… more
- Tufts Medicine (Lawrence, MA)
- **Tufts Medicine Care at Home** is currently seeking an **Associate Medical Director ** to join our **hospice** team in the greater **Lowell** area. This position ... or life-limiting illness. **How You'll Transform Patient Care:** + Provide direct medical care, disease management, pain and symptom management of hospice patients.… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Director , BH Provider Contracting initiates, negotiates, and executes physician, hospital, and/or other ... provider contracts and agreements with behavioral health providers. The Director , BH Provider Contracting requires an in-depth understanding of how organization… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Associate Director , Actuarial provides actuarial support across a broad range of actuarial and business ... needs for specific product lines. The Associate Director , Actuarial requires a solid understanding of how organization capabilities interrelate across department(s).… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …with national and state agencies and regulatory bodies. The Director is also responsible for developing and communicating robust regulatory guidance throughout ... Reporting to the Senior Director , Quality Assurance and Regulatory Compliance, the ...Department of Public Health (DPH), and the Centers for Medicare and Medicaid Services (CMS). This includes understanding and… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Director , IT Vendor Management establishes and implements hardware and software acquisition, protection, ... and procedures that are aligned with IT standards and strategy. The Director , IT Vendor Management requires an in-depth understanding of how organization… more
- Humana (Boston, MA)
- …our caring community and help us put health first** The Associate Director , Cloud Architecture designs, builds, and maintains data processing architectures and ... and unstructured data to insights at enterprise scale. The Associate Director , Cloud Architecture requires an in-depth understanding of how organization capabilities… more
- Pfizer (Cambridge, MA)
- ** Director , US Market Access Marketing Oncology, Sasanlimab and Mevrometostat** **ROLE SUMMARY** The incumbent, within the US Market Access Marketing (USMA-M) team, ... development of the Customer/Brand engagement strategy for top accounts within Commercial, Medicare , and other channels as appropriate based on clinical and economic… more