- 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 ...Prefer Medicaid experience + Utilization management experience in a medical management review organization, such as Medicare … 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
- 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 ... 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
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Scientist supports analytic activities associated with BCBSMA overall performance on Medicare Stars ratings, with specific focus on CAHPS patient experience ... to help identify the most efficient means through which Medicare Stars clinical quality and patient experience performances at...into a cohesive view. Under direction of the Senior Director of Population Health Analytics, the Data Scientist will… 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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Providence, RI)
- …determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Director will learn National LTSS State ... community and help us put health first** The Long-term services and supports (LTSS) Medical Director 's primary responsibility is the review of medical … 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. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… 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 ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… 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...compliance and assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations,… 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 ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- CVS Health (Woonsocket, RI)
- …workflows to enhance accuracy and productivity. * Collaborate closely with the SIU Medical Director to align coding practices with organizational goals. * Work ... care more personal, convenient and affordable. **Position Summary:** As the Coding Director , you will oversee the coding operations, ensuring accurate and efficient… 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 ... to drive meaningful change beyond the bedside? Evolent Health is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in… more
- Tufts Medicine (Boston, MA)
- …support to the Associate CMO for Graduate Medical Education, TM Entity Medical Education Physician Leaders and the Director of Simulation, as needed. This ... Education (OCE) at Tufts Medicine oversees the following components: Graduate Medical Education, Undergraduate Medical Education, Physician Assistant Education… 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
- Point32Health (Canton, MA)
- …service lines for Medicare , Medicaid and Commercial product lines. The Director also identifies opportunities to reduce medical and administrative costs by ... to our members, partners, colleagues and communities. **Job Summary** The Director , Ancillary Contracting leads the development and management of Point32Health's… more
- NASCO (Boston, MA)
- **Overview** As Executive Director , Compliance you will lead and provide oversight and management of Compliance and Privacy functions and serve as the company's ... Compliance Office. This role will have oversight responsibility for Medicare Advantage and ACA Exchanges strategy and executive relationship responsibility… 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 ... ideal candidate will possess a deep understanding of the Medicare landscape, strong analytical skills and the ability to...field + 8+ years of work experience in large national plans, strategic consulting, market analysis and/or finance +… more
- Elara Caring (North Easton, MA)
- … medical conditions), race, color, age (40 and older), national origin, religion, disability, genetic information, marital status, sexual orientation, gender ... the Right Time, in the Right Place. **Job Description:** **Branch Director ** **FULL TIME** **Monday-Friday, 8am-5pm** **$85,000-$90,000 (may be negotiable based on… 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