- CVS Health (Trenton, NJ)
- …of utilization management, quality management, network management and clinical coverage and policies. **Primary Job Duties & Responsibilities:** Behavioral Health ... Medical Director + Collaborates with health plan Sr Leadership to...and interprets medical policies and procedures, including service authorization, claims review, discharge planning, and medical reviews performed through… more
- Humana (Trenton, NJ)
- …The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director reviews cases of ... and complexity ranging from moderate to substantial. The Corporate Medical Director reviews medical necessity and appropriateness of services rendered by healthcare… more
- Zurich NA (Trenton, NJ)
- VP, Territory Director , Commercial Surety, Central Region 113231 Zurich is currently looking for a VP, Territory Director for our Commercial Surety Group in the ... business relationships and oversight on strategic underwriting practices. The VP, Territory Director , Commercial Surety is responsible for: + Managing a team of… more
- RELX INC (Philadelphia, PA)
- Director of Data Content and Strategy About the business: LexisNexis Risk Solutions is the essential partner in the assessment of risk. Within our Healthcare ... to help healthcare organizations make confident decisions and solve complex challenges. You can learn more about LexisNexis Risk...and experienced professional to join our team as the Director of Data Content and Strategy. This critical role… more
- Cardinal Health (Trenton, NJ)
- …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
- Norstella (Trenton, NJ)
- …efforts as needed. **Qualifications:** + Experience working with large and complex healthcare datasets (including Claims , EMR, Lab), preferably patient-level ... Director , RWD Product Company: MMIT Location: Remote, United...commercialize analytics use cases that may include market access, coverage / lives, and RWE data. + Effectively partner… more
- Stantec (Philadelphia, PA)
- …with Earned Value management and forecasting. + Experience with scheduling large, complex projects. + Experience with claims management for design projects. ... System selection to be based on Project/Client needs as well as proactive Claims /Risk mitigation. + Oversee and approve development and management of the Project… more
- Pfizer (Collegeville, PA)
- …subject matter experts and visionary practitioners. This position will report to the Director , Measurement and Optimization, and will be a key resource in driving ... industry and healthcare environment, specifically with an understanding of healthcare claims data and its application to marketing optimization + We look… more
- Pfizer (Collegeville, PA)
- …tools. These tools and underlying data sets are key enablers for highly complex analytic and reporting processes that support $100+ million dollar market access ... users in planning and prioritizations efforts with DTR Project Director , Pfizer Digital and vendors - understanding what those...and/or provider data (eg, IQVIA / Symphony, MMIT, internal claims data, payer portal data) + Skilled in Excel,… more
- WTW (Philadelphia, PA)
- …"the analytical broker". Simply put, our purpose is to reduce the likelihood of claims and reduce the cost of incidents when they occur through a smart, technical ... Role** We have an exciting opportunity as an Associate Director within our **North America Enterprise Risk Consulting** practice,...currently work with some of the world's largest and complex organizations to assess and manage their strategic and… more
- The Cigna Group (Philadelphia, PA)
- …claim trend targets are met. + Utilize internal data such as claims , completed negotiations and network composition along complete and external benchmarking to ... with Network Directors, Medical Directors, and product leadership to create new coverage policies for innovative reimbursement structures and new product designs as… more