• Medical Director - National

    Humana (Providence, RI)
    …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
    Humana (11/08/24)
    - Save Job - Related Jobs - Block Source
  • Medical Director - Medicare

    CVS Health (Providence, RI)
    …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
    CVS Health (10/31/24)
    - Save Job - Related Jobs - Block Source
  • Pharmacy Account Director , Medicare

    Elevance Health (Smithfield, RI)
    …deliver member-centered, lasting pharmacy care. In this pivotal role on our CarelonRx Medicare Sales and Account Management team, the Pharmacy Account Director ... preserving and deepening relationships with clients which include Elevance Health Medicare Health Plans. This position, structured around geographic regions and… more
    Elevance Health (12/24/24)
    - Save Job - Related Jobs - Block Source
  • Medical Director - OneHome/Home…

    Humana (Providence, RI)
    …and help us put health first** Job Description Summary The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing ... 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 (12/21/24)
    - Save Job - Related Jobs - Block Source
  • Medical Director - Mid West Region

    Humana (Providence, RI)
    **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 (10/29/24)
    - Save Job - Related Jobs - Block Source
  • Medical Director - Florida

    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 (12/14/24)
    - Save Job - Related Jobs - Block Source
  • Reviewing Medical Director

    Conviva (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
    Conviva (12/11/24)
    - Save Job - Related Jobs - Block Source
  • Medical Director --Claims Management

    Humana (Providence, RI)
    **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 (10/29/24)
    - Save Job - Related Jobs - Block Source
  • Field Medical Director , Cardiology

    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. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
    Evolent (11/15/24)
    - Save Job - Related Jobs - Block Source
  • Director , Market Finance

    Humana (Providence, RI)
    …a part of our caring community and help us put health first** The Director , Market Finance is a financial leadership position with a significant focus on strategy ... and operations. The Director , Market Finance requires an in-depth understanding of how...work closely with the RVP, Operations, including exposure to Medicare Advantage bid strategy, regional operations staffing, and administrative… more
    Humana (12/19/24)
    - Save Job - Related Jobs - Block Source
  • Corporate Medical Director

    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. The ... Corporate Medical Director works on problems of diverse scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… more
    Humana (11/27/24)
    - Save Job - Related Jobs - Block Source
  • Field Medical Director -Pulmonology

    Evolent (Providence, RI)
    …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director you will be a key member of the utilization management team. ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
    Evolent (12/09/24)
    - Save Job - Related Jobs - Block Source
  • Behavioral Health Services Regional Medical

    Advocates (Framingham, MA)
    …that values the ideas and contributions of our staff. The Behavioral Health Regional Medical Director (RMD) is a leadership and clinical role within Advocates' ... Behavioral Health Services Division. The RMD serves as Medical Director for the clinics of an...a minimum of $1,000,000/$3,000,000. + Satisfactory report from the National Practitioner Data Bank and absence of Medicare more
    Advocates (11/29/24)
    - Save Job - Related Jobs - Block Source
  • Managing Director , Value Based Care…

    Evolent (Providence, RI)
    …$64M of savings for Medicare in the Shared Savings Program. The Managing Director will report to the SVP Primary Care / President of Evolent Care Partners and ... Medicare and Commercial contracts, including plans related to medical expense management, quality improvement, appropriate risk adjustment, and patient and… more
    Evolent (12/13/24)
    - Save Job - Related Jobs - Block Source
  • Associate Director , Actuarial

    Humana (Providence, RI)
    …of our caring community and help us put health first** The Associate Director , Actuarial provides actuarial support across a broad range of actuarial and business ... needs for specific product lines. The Associate Director , Actuarial requires a solid understanding of how organization capabilities interrelate across department(s).… more
    Humana (12/12/24)
    - Save Job - Related Jobs - Block Source
  • Director , Complex Care Strategy…

    CenterWell (Providence, RI)
    …a part of our caring community and help us put health first** The Director , Complex Care Strategy Advancement will play a pivotal role in driving the strategic ... quality and cost improvement for high-risk senior populations in full risk Medicare arrangements. This individual will be responsible for assessing the value of… more
    CenterWell (12/10/24)
    - Save Job - Related Jobs - Block Source
  • Associate Director Cloud Architecture

    Humana (Providence, RI)
    …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
    Humana (11/02/24)
    - Save Job - Related Jobs - Block Source
  • Execution Director & Black Belt, Health…

    Elevance Health (Smithfield, RI)
    …a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services to Medicaid ... and Billing Organization is looking to hire an Execution Director . Reporting directly to the VP of Grievance &...Domain expertise with health plan operations and back office, Medicare , Medicaid, Grievances & Appeals (G&A), Enrollment, and Billing.… more
    Elevance Health (12/12/24)
    - Save Job - Related Jobs - Block Source
  • Director Healthcare Economics & Trend…

    Baylor Scott & White Health (Providence, RI)
    …adjudicated claims data to uncover trends and assist in managing and understanding incurred medical and pharmacy cost. - The Director will design, develop, and ... Overview:** Reporting to the VP, Value-based Care Analytics, he Director of Healthcare Economics and Trend Analytics will support...Baylor Scott & White Quality Alliance Commercial, DTE, and Medicare (MSSP ACO, Medicare Advantage) lines of… more
    Baylor Scott & White Health (12/21/24)
    - Save Job - Related Jobs - Block Source
  • Web Channel and SEO Director

    CVS Health (Wellesley, MA)
    …and affordable. **Position Summary** The Web Channel Owner role for Aetna Medicare is a critical position in our Marketing organization, with accountability for ... shepherd the delivery of Digital Marketing's capabilities backlog for Aetna.com/ Medicare , AllinaHealthAetnaMedicare.com, the Shop, Buy, and Enroll tool, and more,… more
    CVS Health (12/13/24)
    - Save Job - Related Jobs - Block Source