- Humana (Providence, RI)
- …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
- Humana (Providence, RI)
- …analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides ... caring community and help us put health first** The Medical Director relies on medical ...Prefer Medicaid experience + Utilization management experience in a medical management review organization, such as Medicare … more
- CVS Health (Providence, RI)
- …(work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Regulated Medicare Appeals: * Direct daily work on ... encumbrances * Board Certified in ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals… more
- CVS Health (Providence, RI)
- … Medicaid Services) requires regulatory changes during the plan year. The ** Medicare ** **Benefits Standards & Guidance Lead Director ** ensures accountability for ... Individual general enrollment, Special Needs Plans (SNP) and Employer Groups. The ** Medicare ** **Benefits Standards & Guidance Lead Director ** acts as the… more
- Humana (Providence, RI)
- **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 (Providence, RI)
- …community and help us put health first** The Long-term services and supports (LTSS) Medical Director 's primary responsibility is the review of medical ... necessity of a given service, level of care, or medical item/supply. The Medical Director 's...experience + Knowledge of the managed care industry including Medicare or Medicaid products + Possess analysis and interpretation… more
- Humana (Providence, RI)
- **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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Evolent (Providence, RI)
- …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. ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Providence, RI)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Humana (Providence, RI)
- …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...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Evolent (Providence, RI)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Genetic Testing you will be a key member of the utilization ... timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- CVS Health (Woonsocket, RI)
- …workflows to enhance accuracy and productivity. * Collaborate closely with the SIU Medical Director to align coding practices with organizational goals. * Work ... care more personal, convenient and affordable. **Position Summary:** As the Coding Director , you will oversee the coding operations, ensuring accurate and efficient… more
- Athena Health Care Systems (North Easton, MA)
- We are hiring a full-time MDS Director to join our dynamic care team at Southeast Rehabilitation & Skilled Care Center in North Easton! Working with our team and ... you to grow within the company. As the MDS Director , you plan, organize, and direct the MDS process...resident care plans through clinical assessment, review of resident's medical history, personal interviews, and completion of MDS reports.… more
- Evolent (Providence, RI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** **Associate Medical Director - Cardiovascular Medicine (Cardiologist) | Evolent Health** Are you ... beyond the bedside? Evolent Health is seeking an **Associate Medical Director - Cardiovascular Medicine** to play...or disciplinary actions by **state or federal healthcare programs ( Medicare , Medicaid, OIG, or GSA).** Join us at **Evolent… more
- Humana (Providence, RI)
- …our caring community and help us put health first** The Associate Director - Value-based Specialty and Vendor Support role builds templates, standard documentation, ... case studies, and disseminates best in class knowledge. The Associate Director requires a solid understanding of how organization capabilities interrelate across… more
- Humana (Providence, RI)
- …will join the Health Quality and Stars (HQS) leadership team as the Director , Competitive Intelligence to drive the strategic vision of the company's Stars ... Ratings. The ideal candidate will possess a deep understanding of the Medicare landscape, strong analytical skills and the ability to communicate insights… more
- Elara Caring (North Easton, MA)
- …the Right Time, in the Right Place. **Job Description:** **Branch Director ** **FULL TIME** **Monday-Friday, 8am-5pm** **$85,000-$90,000 (may be negotiable based on ... **Join the Elara Caring Mission - Become a Branch Director !** At Elara Caring, we believe that the best...for your education and career growth. + **Comprehensive Benefits:** Medical , dental, vision, and 401(K) with an employer match.… more
- Humana (Providence, RI)
- …community and help us put health first** The Risk Adjustment Compliance Director ensures compliance with governmental requirements. The Risk Adjustment Compliance ... Director requires an in-depth understanding of how organization capabilities...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Humana (Providence, RI)
- …of our caring community and help us put health first** The Director , Corporate Strategy, Long-Term Financial Planning oversees an organization's strategic and ... the development of long-term growth plans and profitability goals The Director , Corporate Strategy, Long-Term Financial Planning oversees an organization's strategic… more
- Humana (Providence, RI)
- …investments. The broad scope of transactions includes provider centric assets, Medicaid, Medicare , Homecare, and IT services. The Director of Investment ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more