- Humana (Providence, RI)
- …analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director for the National Medicare Outpatient Team provides ... caring community and help us put health first** The Medical Director relies on medical ...Prefer Medicaid experience + Utilization management experience in a medical management review organization, such as Medicare … more
- CVS Health (Providence, RI)
- …(work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Regulated Medicare Appeals: * Direct daily work on ... encumbrances * Board Certified in ABMS Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals… more
- CVS Health (Providence, RI)
- … Medicaid Services) requires regulatory changes during the plan year. The ** Medicare ** **Benefits Standards & Guidance Lead Director ** ensures accountability for ... Individual general enrollment, Special Needs Plans (SNP) and Employer Groups. The ** Medicare ** **Benefits Standards & Guidance Lead Director ** acts as the… more
- 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 (Providence, RI)
- …community and help us put health first** The Long-term services and supports (LTSS) Medical Director 's primary responsibility is the review of medical ... necessity of a given service, level of care, or medical item/supply. The Medical Director 's...experience + Knowledge of the managed care industry including Medicare or Medicaid products + Possess analysis and interpretation… more
- 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...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- 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. ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Providence, RI)
- …in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Humana (Providence, RI)
- …our caring community and help us put health first** The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The ... Behavioral Health Medical Director work assignments involve moderately complex...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Evolent (Providence, RI)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Genetic Testing you will be a key member of the utilization ... timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- South County Hospital (Wakefield, RI)
- South County Hospital is seeking a Medical Director for its Division of Hematology and Oncology. The Medical Director is responsible for the overall ... for all patients cared for within the Department. The Medical Director will work in partnership with...5-Star Overall Rating for Quality from the Centers for Medicare and Medicaid. In addition, we have 5 ambulatory… more
- Evolent (Providence, RI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** **Associate Medical Director - Cardiovascular Medicine (Cardiologist) | Evolent Health** Are you ... beyond the bedside? Evolent Health is seeking an **Associate Medical Director - Cardiovascular Medicine** to play...or disciplinary actions by **state or federal healthcare programs ( Medicare , Medicaid, OIG, or GSA).** Join us at **Evolent… more
- Humana (Providence, RI)
- …our caring community and help us put health first** The Associate Director - Value-based Specialty and Vendor Support role builds templates, standard documentation, ... case studies, and disseminates best in class knowledge. The Associate Director requires a solid understanding of how organization capabilities interrelate across… more
- Humana (Providence, RI)
- …will join the Health Quality and Stars (HQS) leadership team as the Director , Competitive Intelligence to drive the strategic vision of the company's Stars ... Ratings. The ideal candidate will possess a deep understanding of the Medicare landscape, strong analytical skills and the ability to communicate insights… more
- Humana (Providence, RI)
- …community and help us put health first** The Risk Adjustment Compliance Director ensures compliance with governmental requirements. The Risk Adjustment Compliance ... Director requires an in-depth understanding of how organization capabilities...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- Humana (Providence, RI)
- …and be their most productive. Against that backdrop, we are seeking a Director of Financial Operations of Home Health Solutions who will provide program ... leadership can evaluate alternatives against the organization's business objectives. The Director of Financial Operations requires a strong understanding the Home… more
- Humana (Providence, RI)
- …of our caring community and help us put health first** The Director , Corporate Strategy, Long-Term Financial Planning oversees an organization's strategic and ... the development of long-term growth plans and profitability goals The Director , Corporate Strategy, Long-Term Financial Planning oversees an organization's strategic… more
- Humana (Providence, RI)
- …investments. The broad scope of transactions includes provider centric assets, Medicaid, Medicare , Homecare, and IT services. The Director of Investment ... your life extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan, time off (including… more
- CVS Health (Providence, RI)
- …make health care more personal, convenient and affordable. Aetna is seeking a Director of Network Pharmacy to lead Strategy and Performance management across all ... to members. In close partnership with Caremark, the Aetna Director of Network Pharmacy will ensure optimized access points...the network. + Drive clinical and cost interventions for medical and specialty pharmacy by leveraging data and analytics… more
- CenterWell (Providence, RI)
- …Leaders to identify and influence enhancements to technology to improve the medical coder experience. + Oversees coding operations by identifying business partner ... of management experience + 8 or more years of Medical Coding, IPA, or similar experience + Medical...up to 20% **Preferred Qualifications** + Proven experience with Medicare Advantage risk adjustment functions. + Proven track record… more