- Highmark Health (Hartford, CT)
- …current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and ... **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions,… more
- Humana (Hartford, CT)
- …of providing frameworks to maximize available resources to achieve growth. The ** Director ,** ** Medicaid Insurance Product Management and Wellness Strategy** will ... caring community and help us put health first** Humana Medicaid is seeking exceptional candidates to join our ...(10-25% of time) This position is open to working remote within the US but prefer the qualified candidate… more
- Humana (Hartford, CT)
- …a part of our caring community and help us put health first** The Director , Actuarial of Medicaid Pricing provides actuarial support across a broad range ... understanding of how organization capabilities interrelate across the function or segment. The Director , Actuarial of Medicaid Pricing may be responsible for any… more
- Prime Therapeutics (Hartford, CT)
- …our passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description ... Summary** Responsible for support and development of Medical Pharmacy program strategy as part of the Medical Pharmacy Business Development team. Responsible for… more
- Humana (Hartford, CT)
- …a part of our caring community and help us put health first** Director of Enterprise Information Protection (EIP) Cybersecurity Engineering focused on building a ... decentralized systems. * Google Cloud Professional Machine Learning Engineer * Agile Remote /WAH requirements: + WAH requirements: Must have the ability to provide a… more
- Humana (Hartford, CT)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... to operationalize this knowledge in their daily work The Medical Director 's work includes computer-based review of...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Hartford, CT)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director reviews cases of diverse scope...protect member PHI / HIPAA information This is a remote position reporting to Grievance and Appeals Director… more
- Arvinas (New Haven, CT)
- …As a key member of the Market Access Leadership team, the Senior Director , US Pricing & Contracting Strategy will lead the function developing and executing ... Understanding of Benefit Design & Economics associated with Commercial, Medicaid and Medicare reimbursement for oral drugs with Oncology...+ MBA or other advanced degree is a plus. \#LI- Remote _Arvinas is proud to offer a competitive package… more
- Elevance Health (Wallingford, CT)
- **Process Improvement Director -Enterprise HEDIS** **Location:** This position will work a hybrid model ( remote and office). Must reside within 50 miles/1hour ... commute from an Elevance Health location. The **Process Improvement Director -Enterprise HEDIS** is responsible for identifying opportunities for improvement,… more
- Cardinal Health (Hartford, CT)
- …team is passionate about helping oncology practices navigate the future. The Director , Managed Care is responsible for strategy and management of managed care ... responsible to implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing… more
- HealthEdge Software Inc (Hartford, CT)
- …to solve critical needs in healthcare. This individual will report to the Chief Medical Officer of Healthedge (HE) and ensure that our clinical suite of products ... Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other...Work across multiple time zones in a hybrid or remote work environment. + Long periods of time sitting… more
- Elevance Health (Wallingford, CT)
- **JR124224 Business Change Director (Quality Control Test Architect, PBM systems)** CarelonRx's Business Operations org is looking to hire a PBM Test Program Manager ... business system integrations. **Location:** This position will work in a hybrid model ( remote and office) with once a week from the nearest Elevance Health… more
- Prime Therapeutics (Hartford, CT)
- …every decision we make. **Job Posting Title** Pharmacy Network Manager - Remote **Job Description** The Pharmacy Network Manager is responsible for development and ... industry; including 3 years of managed care experience in medical or pharmacy network contracting + Must be eligible...+ Knowledge of and experience within health care/PBM industry, Medicaid , Medicare and health plans + Familiarity with contract… more