- 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 ... materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of… more
- Humana (Hartford, CT)
- …our caring 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...conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare… more
- CVS Health (Hartford, CT)
- …process, drive us to deliver unparalleled results. We are seeking an Executive Director to lead the newly formed **Group Medicare Performance Optimization** ... understanding of CMS regulations such as the Inflation Reduction Act (IRA), Medicare Prescription Payment Plan(M3P)as well as Indirect Medical Education (IME)… more
- CVS Health (Hartford, CT)
- …in new and exciting ways every day. Aetna is recruiting for an Executive Director , Actuarial who will be responsible for understanding and driving action on ... Medicare Network Insights and curating support for this important...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… more
- CVS Health (Hartford, CT)
- …health care more personal, convenient and affordable. **Position Summary** The Lead Director , Project Program Management will lead a cross-functional team focused on ... delivering large, complex strategic initiatives for the Medicare Organization. In a matrix management capacity, you will...our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll… more
- The Cigna Group (Bloomfield, CT)
- …is a ** Medicare Advantage position** WORK LOCATION: REMOTE position The ** National Ancillary Medicare Advantage (MA) Provider Contracting Senior Advisor** is ... Clinical and Strategic Sourcing; and is** responsible for negotiating Medicare Advantage national contracts within specified service...NANPM Team and a direct report to the Senior Director of NANPM Medicare & Commercial Alignment.… more
- The Cigna Group (Bloomfield, CT)
- Pima County based - Medicare Provider Performance Enablement (PPE) Senior Analyst provides broad support to Sr. Supervisor, Sr. Manager, Director , and Other ... interaction with PPE staff as well as other Cigna Medicare departments. Position is exposed to all aspects of...internal departments, including but not limited to Health Services, Medical Economics, Sales and Coding in order to develop… more
- The Cigna Group (Bloomfield, CT)
- …Senior Manager will work with the Provider Data Quality & Accuracy (PDQA) Director to establish the framework and policies to drive improvements in the provider ... Functions and Responsibilities** + Coordinate and partner with the key Medicare operations teams, including claims, enrollment, fulfillment, network operations, and… 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
- CVS Health (Hartford, CT)
- …**Position Summary** CVS Health, a Fortune 4 company, has an outstanding opportunity for a Medical Director - Medical Affairs. We need a Board Certified ... clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director ( Medical Affairs) will report into… 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
- CenterWell (Hartford, CT)
- …under the PCO's Chief Medical Officer. This role reports to the National Director , High Risk Patient Management. Responsibilities will include: + Lead ... caring community and help us put health first** The National Director , Clinical Pharmacy is a strategic...and promote age-friendly care + Maintain current knowledge of pharmacy/ medical trends within ambulatory/primary care and Medicare … more
- CVS Health (Hartford, CT)
- …clinical coverage and policies. **Primary Job Duties & Responsibilities:** Behavioral Health Medical Director + Collaborates with health plan Sr Leadership to ... and services for aligned plan's members. Position Description: Aetna Medicare Duals Center of Excellence is searching for a...the delivery of holistic and integrated person-centered care. The Medical Director will be responsible for provider… 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
- Humana (Hartford, CT)
- …community and help us put health first** The Health Quality & Stars, Medical Cost Management, and Clinical Analytics organization is looking for a seasoned leader ... results and does so efficiently and effectively. **Location:** remote The Director , Strategy Advancement provides data-based strategic direction to identify and… more
- CVS Health (Hartford, CT)
- …Process Insights and Reengineering (APIR) team is functional unit of the Medicare Member Experience organization that engages with various business areas to mine ... As a key member the APIR team, the Lead Director will be expected to: + Serve as a...states. + Establish qualitative and quantitative connections between the Medicare member journey and the underlying business processes and… 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:** ... including, but not limited to Provider staff, administrative support staff, medical assistants, nurses, activities assistants, rehab staff, health aides and others.… more
- Humana (Hartford, CT)
- …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
- 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