- Humana (Hartford, CT)
- …or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides medical ... caring community and help us put health first** The Medical Director relies on medical ...or Surgery specialties + Utilization management experience in a medical management review organization, such as Medicare … more
- CVS Health (Hartford, CT)
- …based (work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals. * Direct daily work on part ... 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...* Board Certified in ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance &… more
- Humana (Hartford, CT)
- …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
- CVS Health (Hartford, CT)
- …health care more personal, convenient and affordable. **Position Summary:** As the FP&A Medicare Finance Local Market Senior Analyst, you will work closely with the ... Medicare Finance Lead Directors to analyze financial results, help... Officers. In this role, you support the Lead Director to gather insights into business performance and help… more
- Humana (Hartford, CT)
- …of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and... Medicare population and reports to the Lead Medical Director . **Other duties:** + Identify … more
- Humana (Hartford, CT)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... of the Medicare rules, Humana policies and medical necessity. The Medical Director ...diverse resources, included but not limited to CMS policies, National and Local Coverage Determinations, CMS-recognized Compendia, NCCN, Humana… more
- Humana (Hartford, CT)
- **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 (Hartford, CT)
- **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
- Humana (Hartford, CT)
- **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
- Evolent Health (Hartford, CT)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Medical Director for the Musculoskeletal department, you will be a key member of ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- CVS Health (Hartford, CT)
- …process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject ... CVS Health company has an outstanding opportunity for a Medical Director . Ready to take your career...any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression,… more
- CVS Health (Hartford, CT)
- …convenient and affordable. **Position Summary** Aetna is recruiting for a Lead Director , National VBS Development who will develop innovative and strategic ... provider relationships as part of the National VBS Business Development team. You will work collaboratively across the Network organization to ensure speed to market… more
- National Health Care Associates (Storrs, CT)
- …understanding of Electronic Medical Record (EMR), PDP, MDS 3.0, Medicaid and Medicare requirements + Interest in the nursing needs of the aged and the ... **-** **A Great Place to Work** ** National Health Care Associates is proud to welcome...the Mansfield Center for Nursing & Rehabilitation! **-** MDS Director **What You'll Do:** As an MDS Director… more
- Fallon Health (Springfield, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief summary of purpose:** ... Works closely with SE Site Director to provide day to day oversight of PACE...collection and reporting including those related to the Electronic Medical Record (EHR). Assures that all functions are completed… more
- Humana (Hartford, CT)
- …caring community and help us put health first** The Associate Director , Actuarial Analytics/Forecasting analyzes and forecasts financial, economic, and other data ... medium and long-term financial and competitive position. The Associate Director , Actuarial Analytics/Forecasting requires a solid understanding of how organization… more
- Humana (Hartford, CT)
- …our caring community and help us put health first** The Associate Director , Cloud Architecture designs, builds, and maintains data processing architectures and ... and unstructured data to insights at enterprise scale. The Associate Director , Cloud Architecture requires an in-depth understanding of how organization capabilities… more
- CVS Health (Hartford, CT)
- …to make health care more personal, convenient and affordable. **Lead Sales Director , Growth, CVS Accountable Care** This is a remote opportunity and qualified ... providers and payers in successfully delivering on value-based care programs. The Lead Director , Growth, CVS Accountable Care is a key member of the team with… more
- CVS Health (Hartford, CT)
- …care more personal, convenient and affordable. **Job Purpose and Summary:** The Dental Director - Medicare Appeals is an individual contributor who will assure ... + Basic knowledge of dental benefit products and platforms (DMO, PPO, Medicare Advantage) + Strong understanding of clinical quality programs, and clinical… more
- The Cigna Group (Bloomfield, CT)
- …Delivery and cross-functional teams. * Works with the Evernorth Workplace Care Senior Medical Director , and other clinical leaders, in identifying emerging and ... **_Evernorth Workplace Care - Personalized Care Where You Are_** ** Director , Occupational Health Services** Provides strategic thought leadership and directs… more
- Prime Therapeutics (Hartford, CT)
- …legislative/oversight bodies (eg, URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQA- National Committee for ... passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description Summary**… more