- Humana (Trenton, NJ)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… more
- Humana (Trenton, NJ)
- … management or utilization management . **Additional Information** Reports to a Lead Medical Director . The Medical Director conducts Utilization ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests… more
- J&J Family of Companies (Horsham, PA)
- Associate Director , AI for Medical Data and Advanced Analytics - 2406214851W **Description** Johnson & Johnson Innovative Medicine is searching for an ... **Associate Director , AI for Medical Data and Advanced...priorities. **Competencies:** + Hands - on experience using healthcare claims datasets, electronic health records, and specialty pharmacy data… more
- Humana (Trenton, NJ)
- …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 scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with… more
- The Cigna Group (Philadelphia, PA)
- …and support delivery of plan KPIs. + Oversee end-to-end operations, including claims management , contract administration, account management , and producer ... revenue annually with earnings of approximately $1B. The senior director of Stop Loss will be responsible for protecting...risk, and presenting innovative solutions to the market. The management process will pull in dedicated leaders who drive… more
- Sedgwick (Trenton, NJ)
- …rounding ability + Strong understanding of workers compensation, liability and disability claims management + In-depth knowledge of client servicing + Ability ... Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Client Services Director - Casualty | CST & EST Time Zones...EST Time Zones **PRIMARY PURPOSE** : To determine account management strategies related to client service plans; to be… more
- Takeda Pharmaceuticals (Trenton, NJ)
- …to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director , Global Labeling Lead where you will be responsible for the development ... guidance. **How you will contribute:** With guidance from leadership: Management of Labeling Cross-Functional Teams + Independently leads Labeling cross-functional… more
- HomeSafe Alliance (Trenton, NJ)
- **Title:** Operations Supervisor - Move Management (International Alaska) **_HomeSafe Alliance_** is the single global household goods movement manager of over ... directly or through PPM options + Provide consolidated oversight and management of coordinators under supervision + Monitor international operations performing… more
- WTW (Philadelphia, PA)
- …Risk and Broking** Segment. The business supports an integrated approach to risk management by advancing "the analytical broker". Simply put, our purpose is to ... reduce the likelihood of claims and reduce the cost of incidents when they...Role** We have an exciting opportunity as an Associate Director within our **North America Enterprise Risk Consulting** practice,… more
- Evolent Health (Trenton, NJ)
- …Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for processing ... medical treatment requests in accordance with departmental policies, regulatory...contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Intake Utilization … more
- Stantec (Philadelphia, PA)
- …and forecasting. + Experience with scheduling large, complex projects. + Experience with claims management for design projects. + Sound knowledge and experience ... Claims /Risk mitigation. + Oversee and approve development and management of the Project Scope WBS. + Oversee and...Internal (PGC) Monthly Reports; issue following review with Design Director . + Responsible for the formulation of the Project… more
- Prime Therapeutics (Trenton, NJ)
- …with data consolidation and modeling + Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + ... with business partners across client facing divisions, product/ project management , analytics, operations, and IT to enable data-driven strategic decisions.… more
- AON (Philadelphia, PA)
- Managing Director , Account Executive IV - Philadelphia,PA Senior Account Executive We are looking for a senior leader who is responsible for the day-to-day, account ... management of Aon's relationships with assigned clients as their...to support clients in unusual circumstances such as large claims , etc. + Involves others across geographic (including international),… more
- BAYADA Home Health Care (Pennsauken, NJ)
- …Complete claim denial management functions to ensure timely follow-up with denied claims and complete root causes analysis to determine ways to prevent claims ... from denying. + Process balance transfers, adjustment requests, refunds and corrected claims as part of accounts receivable management responsibilities. +… more
- Penn Medicine (Philadelphia, PA)
- …leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across ... Retail Pharmacy **Summary:** + Under the general observation of the Associate Director of Pharmacy and the Outpatient Pharmacy Managers, the Ambulatory Regulatory… more
- IGT (Trenton, NJ)
- …to track sales compared to historical data. Create reports and communicate findings to management . * Work with the Senior Director of Marketing to develop ... Jersey Lottery Group, LLC (NSNJ) is the lottery growth management services provider selected by the New Jersey Lottery...- Draw Games will work directly with the Senior Director of Marketing to ensure flawless execution of all… more
- Prime Therapeutics (Trenton, NJ)
- …and program impact measurement using eligibility, medical , and pharmacy administrative claims and external data, (eg, care management , disease management ... advanced scientific model design, including advanced predictive modeling, with health claims data, applying statistical theories and methods to solve complex… more
- New Jersey Housing and Mortgage Finance Agency (Trenton, NJ)
- …(https://phh.tbe.taleo.net/phh03/ats/careers/v2/applyRequisition?org=NEWJERSH2&cws=40&rid=747) NOTICE OF VACANCY THE EXECUTIVE DIRECTOR OF THE NEW JERSEY HOUSING AND ... the tracking and updating of servicing pipelines (bankruptcy, foreclosure, conveyance, claims , REO and others as required). 5. Process disbursements, payments and… more
- Community Legal Services, Inc. (Philadelphia, PA)
- …Attorney is a new position that will report to and support the Deputy Director of Legal Practice. The position will focus on ensuring CLS practices and procedures ... procedures to ensure clarity, operational effectiveness, compliance and to support risk management + Reviews and manages potential professional liability issues and … more
- Planate Management Group LLC (Philadelphia, PA)
- Planate Management Group (PMG ) is a Service-Disabled Veteran-Owned Small Business (SDVOSB) headquartered in Alexandria, Virginia, and Orlando, Florida USA with ... South East Asia and East Africa, that provide program management and facilities engineering services worldwide. Planate is a...a unique opportunity to work closely with the Project Director (PD) and Office of Building Operations (OBO) staff,… more