- Daiichi Sankyo, Inc. (Boston, MA)
- …research areas centered around rare diseases and immune disorders. Summary: The Associate Director Field Reimbursement (ADFR) is a critical front-line member ... the appropriate utilization of NCCN/ASCO guidelines, private payer, GPOs, Medicare and Medicaid structure, Specialty Pharmacy systems and reimbursement processes… more
- Humana (Boston, MA)
- …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 to complex issues...authorized. All work occurs within a context of regulatory compliance and work is assisted by diverse resources which… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources, which...and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will… more
- Humana (Boston, MA)
- …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 and complexity ranging...and appropriateness of services rendered by healthcare professionals in compliance with CMS guidelines, clinical coverage criteria, and quality… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the creation of controls to manage fraud, waste and abuse schemes. + Support the Medicare compliance program by overseeing Medicare fraud waste and abuse ... on fraud waste and abuse work, present to the Medicare Compliance Committee and manage requests and...and that work/life balance is a key part of associate wellbeing. For more information on how we work… more
- Humana (Boston, MA)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Humana (Boston, MA)
- …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 ... requires an in-depth evaluation of variable factors. **Job Profile** The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Boston, MA)
- …**Additional Information** Typically reports to a Lead, may also report to a Regional/ Associate Vice President or Corporate Medical Director , depending on size ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… 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)
- …a part of our caring community and help us put health first** The Director , Provider Activation is responsible for the end-to-end process of adding providers to ... increase productivity, and oversees execution of relevant initiatives. The Director , Provider Activation motivates, manages, and leads high-performance teams… more
- Commonwealth Care Alliance (Boston, MA)
- … Risk Assessment. + Make recommendations towards enhancements to the Continuous Compliance Risk Assessment process. + Alert Director of Internal Audit ... Role is Important to Us:** Under direction of the Director of Internal Audit, the primary functions of this...and Compliance infrastructure at CCA. + Promote compliance in CCA's business operations with all Medicare… more
- Beth Israel Lahey Health (Burlington, MA)
- …of the Director of the Medical Education Department and the Program Director to ensure program compliance with the ACGME (Accreditation Council for Graduate ... duty hour tracking is up to date in New Innovations Database for ACGME compliance and Finance Department reference for Annual Medicare Cost Report submission. +… more
- Humana (Boston, MA)
- …us put health first for our members, providers and ourselves. Desired Lead Associate to lead and manage the enterprise framework to facilitate and document ... work closely with established functions inside utilization management (Medical Director , clinician decision making teams, quality audits, prior authorization list… more
- North Shore Community Health (Peabody, MA)
- …hire date. New procedures can only be added with the written approval of the ( associate ) medical director and the CCO. + Adheres to the documentation standards ... in and compliance with all policies and procedures related to Medicare , Medicaid, other federal and state reimbursement programs, Blue Cross/Blue Shield, and the… more
