- Ryder System (Providence, RI)
- …of assigned staff. Assists Director with other staff as directed. Work with Director and other management team to develop tactics and strategies to achieve ... staff. Handles commercial lines bodily injury and property damage claims as well as insurance and contractual coverage issues....annual metrics and other KPI's + Participates with the Director in the selection and management of… more
- CVS Health (Providence, RI)
- …during the plan year. The **Medicare** **Benefits Standards & Guidance Lead Director ** ensures accountability for the implementation, management , and maintenance ... Employer Groups. The **Medicare** **Benefits Standards & Guidance Lead Director ** acts as the point of contact to our...such as Benefit & Product Strategy, Benefits & Product claims configuration, Medicare Service Operations (MSO), Medical … more
- Humana (Providence, RI)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in the… more
- Humana (Providence, RI)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Humana (Providence, RI)
- … 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
- Aveanna Healthcare (Needham Heights, MA)
- …to the Governing Body, also reporting to Area Vice President, AVP, and/or Area Director , AD. Essential Job Functions Team Management : * Assure evaluation of each ... Executive Director - Home Care ApplyRefer a FriendBack Job...Requisition #: 204053 Location: Needham Heights, MA 02494 Category: Management Salary: $75,000.00 - $80,000.00 per year Position Details… more
- Prime Therapeutics (Providence, RI)
- …our passion and drives every decision we make. **Job Posting Title** Senior Director of Underwriting - REMOTE **Job Description** The Sr. Director Underwriting ... for prospective clients and new customer acquisitions. **Responsibilities** + Analyze claims data and develop cost-of-care projections for existing customer renewals… more
- CVS Health (Providence, RI)
- …+ Innovation and ideation around new areas of data driven impact around medical cost and patient experience + Work closely with other development teams to ... experience in developing and operating innovative healthcare analytic solutions utilizing member, claims , clinical and provider data + 10+ years working with… more
- Trustmark (Providence, RI)
- …+ Collaborate with the sales leadership teams of VP of Sales & Client Management , Senior Directors' Sales, and the whole sales team to maximize opportunities. + ... accounting of activities and sales. + Collaborate with and support the Client Management team to assure persistency goals are being achieved. + Review national… more
- CVS Health (Woonsocket, RI)
- …effective solutions related to the adjudication and processing of pharmacy and medical claims and newly expanded healthcare services. Create and ensure ... effective solutions related to adjudication and processing of pharmacy and vaccine/ medical claims , maintaining current services, support optimalization of… more
- Point32Health (Canton, MA)
- …/ management consultancy or auditing firm. + Understanding of claims systems, provider information, Medicaid/Medicare, and/or experience working with large data ... click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the supervision of the Director of Data and Reporting, this individual will be responsible for… more
- UMB Bank (Providence, RI)
- …across all payment channels. Will work with the Enterprise Fraud Prevention and Claims teams to provide data to help identify emerging fraud trends and UMB's ... concert with the Enterprise Fraud Prevention and Enterprise Fraud Claims teams to identify fraud exposure and make necessary...to fulfill overall business needs and expectations of the Director of Enterprise Fraud Operations and the bank's senior… more
- Riverside Community Care (Dedham, MA)
- …complex environment. + Working knowledge of member eligibility verification, benefits/services, claims management , and quality management functions required. ... improve health outcomes for members with complex and long-term medical and behavioral needs. We seek to improve member...Coordinator, nurses, and interns. In consultation with the Program Director , they will implement and monitor the adoption of… more
- Fallon Health (Worcester, MA)
- …Housing Program apartments as applicable. Functions independently in the day-to-day management of the home care department to assure that participants' home ... data collection and quality surveillance as required. + Collaborates with the Site Director to establish goals and objectives related to home care services. +… more
- Atrius Health (Newton, MA)
- …RESPONSIBILITIES* . | Supports on-going analyses of financial, budgetary, or medical claims data, through forecasting, statistical analyses, trending, regression ... patients across eastern Massachusetts. The Atrius Health practices including Dedham Medical Associates, Granite Medical Group, Harvard Vanguard Medical… more
- Cardinal Health (Providence, RI)
- …on policies. **_Manager, Ethics and Compliance_** Reporting to the Compliance Director , this position is responsible for supporting the programmatic requirements for ... focus include: compliance training, policy development, exclusion screening tracking, management of investigations and development of programmatic presentation materials.… more
- CS Energy (Worcester, MA)
- …effectively utilizing project controls tools and track utilization for reporting to Director of Project Controls + Attend, participate, and contribute to cost ... Support Operations with verifying and checking of invoices and claims from suppliers, vendors, and subcontractors to ensure that...Analysis is a plus + Certification related to Project Management (PMP, PSP, etc) is a plus + Advanced… more