- Humana (Hartford, CT)
- … 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 (Hartford, CT)
- … 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
- Travelers Insurance Company (Hartford, CT)
- …adequacy, and results. Provides direction for claim technical guidance, legal, and medical issues through a continuous process of management involvement and ... Develop and implement process improvement strategies that impact indemnity, medical , and expense management , investigations, subrogation, structured settlements,… more
- Humana (Hartford, CT)
- …us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate ... Medical Director works on problems of diverse scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with… more
- The Cigna Group (Bloomfield, CT)
- …- Performs benefit-driven medical necessity reviews for coverage, case management , and claims resolution, using benefit plan information, applicable federal ... - Participates in coverage guideline development, development, and maintenance of medical management projects, and committees. - Participates in quality… more
- Sedgwick (Hartford, CT)
- …+ Establishes policy and procedures to assure compliance to best practices, claims management services standards, state regulations, and client service ... work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Director , Network Operations **PRIMARY PURPOSE** : To be responsible for the… more
- Elevance Health (Wallingford, CT)
- **JR130960 Business Change Director (Quality Control Test Architect, PBM systems)** CarelonRx's Business Operations org is looking to hire a PBM Test Program Manager ... This high-performing individual contributor will be responsible for working with management to identify and implement varied projects, programs and plans that… more
- Cardinal Health (Hartford, CT)
- …are used. **What this position contributes to Cardinal Health:** The Associate Director , Access and Patient Support (APS) is responsible for the tactical execution ... collaboration and integration with cross functional teams. The Associate Director oversees revenue and budget accountability, organizational development, and… more
- Sedgwick (Hartford, CT)
- …rounding ability + Strong understanding of workers compensation, liability and disability claims management + In-depth knowledge of client servicing + Ability ... Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Client Services Director - Casualty | CST & EST Time Zones...EST Time Zones **PRIMARY PURPOSE** : To determine account management strategies related to client service plans; to be… more
- Elevance Health (Wallingford, CT)
- …Platforms that are enabled across Carelon's Product Portfolio, inclusive of medical benefits management products, behavioral health products, payment integrity ... products, pharmacy benefit management products, specialty risk products, utilization management and prior authorizations. This Director will look across the… more
- Takeda Pharmaceuticals (Hartford, CT)
- …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
- The Cigna Group (Bloomfield, CT)
- The Individual Dental Strategy & Business Development Director will be responsible to maximize Cigna's performance by developing a comprehensive strategy for our ... goals through collaboration with business leaders and owners of relevant management processes, investments, and execution. + Champion strategic change initiatives,… more
- CVS Health (Hartford, CT)
- …Aetna Individual and Family Plans Finance team is looking for a creative Executive Director who will build a Center of Excellence team focused on financial controls. ... This could include leading revenue management best practices for this $10B business, membership reporting...against forecast, across risk adjusted revenue and cost (eg, claims and risk score trends) + Develops the organizations… more
- HomeSafe Alliance (Hartford, CT)
- **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
- CVS Health (Hartford, CT)
- …and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense ... communication, both internally and externally to enhance effectiveness of medical management services (eg, health care providers,...* May assist in the research and resolution of claims payment issues. * Supports the administration of the… more
- Evolent Health (Hartford, CT)
- …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
- Moses/Weitzman Health System (Middletown, CT)
- …**NATURE OF POSITION:** The Clinical Risk Manager leads and oversees risk management efforts at CHC and works collaboratively with the MWHS Legal Department, ... degree. Experience: Minimum 4-5 years of experience in risk management , quality, or public health is required with at...work meets the requirements for the annual Federal Tort Claims Act (FTCA) deeming application and other FTCA reporting… more
- The Cigna Group (Bloomfield, CT)
- …to determine the outcome of the appeal; provide oversight and assistance to Medical Management staff with resolution of appeal by interpreting Medicare and ... well as research and provide a written detailed clinical summary for the Plan Medical Director . + Determine whether additional pre service, appeal or grievance… more
- Genesis Healthcare (Bristol, CT)
- …this position is $215000 / year. The Attending Physician works with the Center Medical Director to ensure that delivery of clinical services achieves the ... Attending Physician's Primary reporting relationship is to the AlignMed Partners Regional Medical Director . The Attending Physician is also accountable to both… more
- Fujifilm (Hartford, CT)
- …limited management oversight. The position will report to the Director of Corporate Compliance. **Duties and responsibilities** + Develop and implement elements ... needs of healthcare across prevention, diagnosis, and treatment. Fujifilm's medical imaging portfolio includes solutions for digital radiography, mammography,… more