- Humana (Providence, RI)
- … 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
- HomeSafe Alliance (Providence, RI)
- …and motivated Assistant Claims Manager to assist in all aspects of claims management , to support and promote process improvement methodologies and best ... Raising awareness of any settlement practices, trends, or areas of concern to the Director of Claims . Responds to internal and external customer disputes and… more
- Humana (Providence, RI)
- …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
- Merck (Providence, RI)
- **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
- Humana (Providence, RI)
- …help us put health first** The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director ... of diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- Merck (Providence, RI)
- …needs to support collaboration to further differentiate our portfolio. The Oncology Regional Medical Scientific Director , RMSD, is a credentialed (ie, MD, PhD, ... **Job Description** Our Medical Affairs team advances patient care by engaging...and scientific community. Scientific exchange does not include promotional claims about any drug, vaccine or biologic product. RMSDs… more
- Cardinal Health (Providence, RI)
- …and delivers human resource programs and policies, including recruitment, talent management , diversity and inclusion, compensation and benefits, among others. This ... **_Job Summary_** We are seeking an experienced and strategic Director of US Benefits to lead and oversee the...Benefits to lead and oversee the design, implementation, and management of employee benefit programs. This role will be… more
- United Therapeutics (Providence, RI)
- …orphan diseases. **How you'll contribute** The Associate Analytics, Insights and Operations Director , Market Access will lead data support across all functions of ... Compliance, Legal, Information Technology, Sales & Marketing Operations, Finance, and Medical Affairs / HEOR. Additionally, this role will support special pricing… more
- HomeSafe Alliance (Providence, RI)
- **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
- Merck (Providence, RI)
- …deliver measurable impact in commercial pharma landscape. + Knowledge in mining medical claims /EMR, social media, etc. data with a strategic/inquisitive mindset ... **Job Description** The Associate Director Data Science will be responsible for developing and communicating data-driven and actionable insights that drive greater… more
- CVS Health (Woonsocket, RI)
- …an Executive Director for Claim Platform Quality Assurance within the Claims Center of Excellence Automation team. This role involves owning the design and ... CVS Health's unrivaled presence in local communities and their pharmacy benefits management capabilities, we're joining members on their path to better health and… more
- Takeda Pharmaceuticals (Providence, RI)
- …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
- Zurich NA (Providence, RI)
- …Member of the Bar + Extensive experience in and in-depth knowledge of Casualty claims management + Highly detail-oriented with a strong focus on accuracy + ... AVP, Medical Bill Review Litigation 119916 Zurich Insurance is...and other legal filings + Maintain accurate and up-to-date claims documentation, ensuring compliance with best practices for high-complexity… more
- HomeSafe Alliance (Providence, RI)
- **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
- Fallon Health (Worcester, MA)
- …detection and analysis, and laws/regulations related to fraud and general risk management . Medical claim terminology, coding, and managed care expertise or ... direction of the Senior Internal Audit Manager, theAnalyze and interpret patient medical records pertaining to FWA investigations Compare to information submitted on… more
- Genesis Healthcare (Cumberland, RI)
- …or on call)! We are seeking a full-time (40 hours per week) Attending Physician/ Medical Director for our Grandview Center, located in Cumberland, RI. The annual ... $215000 / year. This is a Dual Role Attending Physician/ Medical Director . This role is clinical in...within the Compliance Process, Standard/Code of Conduct, Federal False Claims Act and HIPAA. Participate in required orientation and… more
- Prime Therapeutics (Providence, RI)
- …with data consolidation and modeling + Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + ... with business partners across client facing divisions, product/ project management , analytics, operations, and IT to enable data-driven strategic decisions.… more
- CVS Health (Woonsocket, RI)
- …summarization + Experience with administrative claims data such as pharmacy or medical claims + Experience in Retail Pharmacy + Experience in Excel, ... effective solutions related to the adjudication and processing of pharmacy claims and newly expanded healthcare services. Create and ensure custom solutions… more
- Fallon Health (Worcester, MA)
- …and provides direction and support. + Works with Department Supervisors, Manager and/or Director , or Clinical Staff including the Medical Directors to resolve ... FH members and/or provider offices and FH with their authorization management issues. Thorough research, documentation, and corrective action planning must be… more
- Mathematica (Providence, RI)
- …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