- Humana (Providence, RI)
- … 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 (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
- Conviva (Providence, RI)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Physician Leadership in Population Health Strategy at Primary Care Organization. The Medical Director conducts Utilization Management of the care received by… more
- Atrius Health (Newton, MA)
- …settlements with payers and hospitals. Has responsibility for contractually required medical claims expense and utilization reporting under risk-sharing ... recorded against claims "run-out". Works with financial auditors to validate medical claims expense and liabilities under payer and hospital risk… 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
- Merck (Providence, RI)
- **Job Description** **Role Summary** The Regional Medical Scientific Director is a credentialed (ie, PhD, PharmD, DNP, MD) therapeutic and disease expert who ... SLs, including questions about Company products. The work of an Regional Medical Scientific Director is aligned to: Scientific Exchange, Research, Scientific… more
- Western Digital (Providence, RI)
- …of action. + Develop, formulate and coordinate property and casualty insurance claims control function at all locations. + Continue review of existing safety, ... environment, loss prevention, employment and security programs as related to the management of risk or accidental loss. + Maintain historical record of all losses,… more
- Humana (Providence, RI)
- …help us put health first** The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director ... of diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- HomeSafe Alliance (Providence, RI)
- **Title:** Director of International, Global Household Goods Moving Services **_HomeSafe Alliance_** is the single global household goods movement manager of over ... the Role** HomeSafe Alliance is seeking a highly skilled and motivated Director of International, Household Goods Moving Services to drive optimization and improve… more
- Baylor Scott & White Health (Providence, RI)
- … claims data to uncover trends and assist in managing and understanding incurred medical and pharmacy cost. - The Director will design, develop, and support ... **Position Overview:** Reporting to the VP, Value-based Care Analytics, he Director of Healthcare Economics and Trend Analytics will support the Baylor Scott & White… more
- Takeda Pharmaceuticals (Providence, RI)
- …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 (Providence, RI)
- **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
- Fallon Health (Worcester, MA)
- …detection and analysis, and laws/regulations related to fraud and general risk management . Medical claim terminology, coding, and managed care expertise or ... direction of the Senior Internal Audit Manager, theAnalyze and interpret patient medical records pertaining to FWA investigations Compare to information submitted on… more
- Evolent (Providence, RI)
- …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
- Evolent (Providence, RI)
- …and LPCs, Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be available. ... culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of...also works with our clinical team, which includes our medical reviews: LVNs, LPNs, and RNs along with our… more
- Prime Therapeutics (Providence, RI)
- …with data consolidation and modeling + Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + ... **Responsibilities** + Under general supervision, analyze or produce reports of varied claims data to assess Prime's products and/or programs; utilize analytics to… more
- Prime Therapeutics (Providence, RI)
- …+ Experience writing SQL queries + Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + ... as assigned **Minimum Qualifications** + Bachelor's Degree in Business Administration, Management , Economics or related area of study, or equivalent combination of… more
- Fallon Health (Worcester, MA)
- …and provides direction and support. + Works with Department Supervisors, Manager and/or Director , or Clinical Staff including the Medical Directors to resolve ... FH members and/or provider offices and FH with their authorization management issues. Thorough research, documentation, and corrective action planning must be… 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