- Humana (Boston, MA)
- …our caring community and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health care strategy and/or operations. ... The Behavioral Health Medical Director work assignments involve moderately complex...conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare… more
- Elevance Health (Woburn, MA)
- ** Director I Medicare Operations** **Location:** This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one ... Medicare and Medicaid Services to transform federal health programs. The ** Director I Medicare Operations** is responsible for directing multiple business… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …true colors to blue. Reporting to the SVP, Sales & Client Management, the Director , Group Medicare Sales, is an integral member of the leadership team-driving ... BCBSMA's purposeful re-entry into the Group Medicare Advantage Market. The role will have responsibility for Group Medicare Advantage and Medicare … 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 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
- CVS Health (Boston, MA)
- …**Position Summary** CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs. We need a Double Board ... clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director ( Medical Affairs) will report into… 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
- CVS Health (Boston, MA)
- …members' health care and social determinant needs. The Duals Care Management (CM) Medical Director will participate in designing, developing and deploying our ... in both our Dually Eligible Special Needs Plan (DSNP) and our Medicare -Medicaid Plan (MMP) programs. We collaborate with members, providers, and community… more
- CVS Health (Boston, MA)
- …clinical coverage and policies. **Primary Job Duties & Responsibilities:** Behavioral Health Medical Director + Collaborates with health plan Sr Leadership to ... and services for aligned plan's members. Position Description: Aetna Medicare Duals Center of Excellence is searching for a...the delivery of holistic and integrated person-centered care. The Medical Director will be responsible for provider… 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 works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Advocates (Framingham, MA)
- …that values the ideas and contributions of our staff. The Behavioral Health Regional Medical Director (RMD) is a leadership and clinical role within Advocates' ... Behavioral Health Services Division. The RMD serves as Medical Director for the clinics of an...a minimum of $1,000,000/$3,000,000. + Satisfactory report from the National Practitioner Data Bank and absence of Medicare… more
- Humana (Boston, MA)
- …our caring community and help us put health first** The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The ... Behavioral Health Medical Director work assignments involve moderately complex...compliance and assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations,… more
- Elevance Health (Woburn, MA)
- **Reporting and Analytics Director - CAHPS/STARS** **Location:** This position will work a hybrid model (remote and in office one day per week). Ideal candidates ... KY, Wilmington, DE, Tampa, FL or Nashville, TN. The **Reporting and Analytics Director - CAHPS/STARS** is responsible for high-priority analytical projects for the … more
- Point32Health (Canton, MA)
- …key provider - facility and physician or group - clinical leadership. The Director oversees and leads medical management activities related to precertification ... at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director , Utilization Management is responsible for directing, leading, and… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …as an interface between BCBSMA and outside entities including law enforcement and national antifraud associations. The attorney will also oversee compliance for the ... Medicare and Federal Employee programs related to FWA and...senior managers, data analysts, fraud investigators, certified coders and medical providers. + Manage strategy, goal setting and budget… more
- Elevance Health (Hingham, MA)
- ** Director of Contracts & Procurement** **Location:** This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of ... our Elevance Health PulsePoint locations. ** National Government Services** is a proud member of Elevance...Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director of Utilization Management leads and manages all utilization management (UM) functions for physical health services ... federal regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting strategic direction,… 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 of ... actuarial and business needs for specific product lines. The Director , Actuarial requires an in-depth understanding of how organization capabilities interrelate… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Associate Director , Agile Coaching guides, educates, and mentors organizational leaders and their teams to ... including Scrum, Kanban and Scaled Agile Framework (SAFe). The Associate Director , Agile Coaching requires a solid understanding of how organization capabilities… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Director , Broker Digital Sales (Innovation Portfolio Strategy) utilizes ideas, identifies innovation ... opportunities, and translates ideas into actionable and profitable business. The Director , Innovation Portfolio Strategy requires an in-depth understanding of how… more