- Highmark Health (Boston, MA)
- …current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and ... **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions,… more
- Humana (Boston, MA)
- …of providing frameworks to maximize available resources to achieve growth. The ** Director ,** ** Medicaid Insurance Product Management and Wellness Strategy** will ... caring community and help us put health first** Humana Medicaid is seeking exceptional candidates to join our ...(10-25% of time) This position is open to working remote within the US but prefer the qualified candidate… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** The Director , Actuarial of Medicaid Pricing provides actuarial support across a broad range ... understanding of how organization capabilities interrelate across the function or segment. The Director , Actuarial of Medicaid Pricing may be responsible for any… more
- Motion Recruitment Partners (Canton, MA)
- Project Manager - Medicaid Canton, Massachusetts **Open to Remote ** Contract $65/hr - $65/hr Our client is looking for a contract Project Manager - Medicaid . ... to Canton, MA. However, the client is amenable to remote work as long as the candidate resides in...in CST or EST. As the Project Manager - Medicaid , you will be the driving force behind the… more
- Prime Therapeutics (Boston, MA)
- …our passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions -RPH/PharmD required- REMOTE **Job Description ... Summary** Responsible for support and development of Medical Pharmacy program strategy as part of the Medical Pharmacy Business Development team. Responsible for… more
- Humana (Boston, MA)
- …a part of our caring community and help us put health first** Director of Enterprise Information Protection (EIP) Cybersecurity Engineering focused on building a ... decentralized systems. * Google Cloud Professional Machine Learning Engineer * Agile Remote /WAH requirements: + WAH requirements: Must have the ability to provide a… 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 ... to operationalize this knowledge in their daily work The Medical Director 's work includes computer-based review of...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- 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 and ... preservice appeals. The Corporate Medical Director reviews cases of diverse scope...protect member PHI / HIPAA information This is a remote position reporting to Grievance and Appeals Director… more
- WellSense (Boston, MA)
- …Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, ... Director of Finance and Strategy, MassHealth Product WellSense...the WellSense ACO and MCO programs under the Massachusetts Medicaid product known as MassHealth. WellSense's MassHealth enrollment includes… more
- Cardinal Health (Boston, MA)
- …team is passionate about helping oncology practices navigate the future. The Director , Managed Care is responsible for strategy and management of managed care ... responsible to implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing… more
- HealthEdge Software Inc (Boston, MA)
- …to solve critical needs in healthcare. This individual will report to the Chief Medical Officer of Healthedge (HE) and ensure that our clinical suite of products ... Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other...Work across multiple time zones in a hybrid or remote work environment. + Long periods of time sitting… more
- Prime Therapeutics (Boston, MA)
- …every decision we make. **Job Posting Title** Pharmacy Network Manager - Remote **Job Description** The Pharmacy Network Manager is responsible for development and ... industry; including 3 years of managed care experience in medical or pharmacy network contracting + Must be eligible...+ Knowledge of and experience within health care/PBM industry, Medicaid , Medicare and health plans + Familiarity with contract… more
- Commonwealth Care Alliance (Boston, MA)
- …Important to Us:** **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims Coding ... (must have): + 7+ years of Healthcare experience, specific to Medicare and Medicaid + 7+ years progressive experience in medical claims adjudication, clinical… more
- WellSense (Boston, MA)
- …Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, ... Senior Manager will work in conjunction with the Senior Director of Behavioral Health (BH) Clinical Programs on a...government agency requirements. Our Investment in You: . Full-time remote work . Competitive salaries . Excellent benefits **Key… more
- Takeda Pharmaceuticals (Boston, MA)
- …the US, including but not limited to: Medicare national (Centers for Medicare & Medicaid Services [CMS]), Medicaid (state and managed), Medicare Part B regional ... all market access activities. Specifically, work collaboratively with Commercial, Medical Affairs, Legal, Compliance, Regulatory, Government Affairs, Finance, and… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Quality and Patient Safety (QPS) Department. Under the direction of the Director of Risk Management, the Risk Manager is responsible for identification, evaluation, ... and we work with amazing partners, including other Harvard Medical School-affiliated hospitals. This position's work location is hybrid...is hybrid with two or three days per week remote . The selected candidate may only work remote… more