- 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
- The Cigna Group (Bloomfield, CT)
- …+ 7+ years management and leadership experience + Experience building a claims team from the ground up is strongly preferred + Ability to communicate clearly ... The Claims Strategy and Payment Integrity Senior Manager will...who can work closely with Claim Operations, Claim Utilization Management , Provider Operations, Product, IFP's Total Cost of Care… more
- Humana (Hartford, CT)
- …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 (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
- Merck (Hartford, CT)
- **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 (Hartford, CT)
- …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
- Fallon Health (Springfield, MA)
- …of the Site Director . Oversees the timely and accurate processing of claims , data collection and reporting including those related to the Electronic Medical ... for all site participants. Responsible for all site facilities management , working closely with Director of Facilities...PACE site. + Oversees the timely processing of all claims and invoices and referrals, ensuring all external appointments… 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
- HomeSafe Alliance (Hartford, CT)
- **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 (Hartford, CT)
- … 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, the Director of Healthcare Economics and Trend Analytics will support the Baylor Scott &… more
- Humana (Hartford, CT)
- …our caring community and help us put health first** The Actuarial Director , Analytics/Forecasting analyzes and forecasts financial, economic, and other data to ... short, medium and long-term financial and competitive position. The Director , Actuarial Analytics/Forecasting requires an in-depth understanding of how organization… 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
- 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
- Evolent (Hartford, CT)
- …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
- The Cigna Group (Bloomfield, CT)
- …and support delivery of plan KPIs. + Oversee end-to-end operations, including claims management , contract administration, account management , and producer ... revenue annually with earnings of approximately $1B. The senior director of Stop Loss will be responsible for protecting...risk, and presenting innovative solutions to the market. The management process will pull in dedicated leaders who drive… more
- Prime Therapeutics (Hartford, CT)
- …+ 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
- Mathematica (Hartford, CT)
- …or APCD claims data; EHR and/or HIE data; healthcare informatics; medical coding). * Ability to describe difficult technical problems and solutions to a ... data pipelines and analyses involving large administrative data sources such as state Medicaid claims and APCDs, as well as clinical data sources such as EHRs and… more
- Hartford HealthCare (Farmington, CT)
- …now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system. ... in active inventory and provides leadership to supervisors and staff including management of human resources, vendors, and client relations. Reports directly to … more
- Prime Therapeutics (Hartford, CT)
- …) experience + Experience conducting complex analysis on large sets of pharmacy, claims , medical , and/or financial data + Basic to intermediate SAS coding ... adjust focus **Reporting Structure** + Reports to Manager or Director in the Network Management , Consulting Analytics...to Manager or Director in the Network Management , Consulting Analytics or Operations & Planning department Potential… more