• Medical Director - National

    Humana (Boston, MA)
    …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
    Humana (03/11/25)
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  • Medicare Benefits Standards & Guidance Lead…

    CVS Health (Boston, MA)
    … 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 (03/14/25)
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  • Data Scientist, Medicare Stars Analytics

    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
    Blue Cross Blue Shield of Massachusetts (02/13/25)
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  • Sr. Program Manager Quality - Medicaid/…

    Fallon Health (Worcester, MA)
    …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... Twitter and LinkedIn. **Brief Summary of Purpose:** With general direction from the Director of Quality, the Senior Program Manager ensures that the health plan is… more
    Fallon Health (01/08/25)
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  • Medical Director - Mid West Region

    Humana (Boston, MA)
    **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 (03/04/25)
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  • Physician Medical Director - LTSS

    Humana (Boston, MA)
    …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 (01/25/25)
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  • Medical Director - Medicaid N.…

    Humana (Boston, MA)
    **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
    Humana (03/11/25)
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  • Field Medical Director , Cardiology

    Evolent (Boston, MA)
    …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 (02/14/25)
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  • Field Medical Director

    Evolent (Boston, MA)
    …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
    Evolent (01/30/25)
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  • Behavioral Health Medical Director

    Humana (Boston, MA)
    …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
    Humana (02/15/25)
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  • Field Medical Director , Genetic…

    Evolent (Boston, MA)
    …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
    Evolent (02/18/25)
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  • Behavioral Health Services Regional Medical

    Advocates (Framingham, MA)
    …that values the ideas and contributions of our staff. The Behavioral Health Regional Medical Director (RMD) is a leadership and clinical role within Advocates' ... Behavioral Health Services Division. The RMD serves as Medical Director for the clinics of an...a minimum of $1,000,000/$3,000,000. + Satisfactory report from the National Practitioner Data Bank and absence of Medicare more
    Advocates (01/23/25)
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  • Associate Medical Director

    Evolent (Boston, MA)
    …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
    Evolent (03/04/25)
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  • Director Graduate Medical Education

    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
    Tufts Medicine (03/15/25)
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  • Associate Director - Value-Based Specialty…

    Humana (Boston, MA)
    …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 (03/04/25)
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  • Executive Director , Compliance

    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
    NASCO (02/11/25)
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  • Site Director - (PACE Center) - Great…

    Fallon Health (Lowell, MA)
    …team of professionals and have access to social support and a wide array of medical services in one convenient location while they keep the independence of living in ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief Summary of Purpose:**… more
    Fallon Health (02/12/25)
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  • Director , Competitive Intelligence, Stars

    Humana (Boston, MA)
    …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
    Humana (03/04/25)
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  • Director , Clinical Regulatory Compliance

    Dana-Farber Cancer Institute (Brookline, MA)
    …with national and state agencies and regulatory bodies. The Director is also responsible for developing and communicating robust regulatory guidance throughout ... Reporting to the Senior Director , Quality Assurance and Regulatory Compliance, the ...Department of Public Health (DPH), and the Centers for Medicare and Medicaid Services (CMS). This includes understanding and… more
    Dana-Farber Cancer Institute (01/17/25)
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  • Branch Director Spanish Speaking

    Elara Caring (Boston, 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
    Elara Caring (03/07/25)
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