• Medicare Grievances and Appeals Corporate…

    Humana (Boston, MA)
    …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The ... Corporate Medical Director works on problems of diverse scope and complexity...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… more
    Humana (01/07/25)
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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 (12/19/24)
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  • Senior Manager, Medicare Product…

    Point32Health (Canton, MA)
    …are approved by senior leadership, the Senior Manager, in collaboration with the Director , is responsible for all necessary product filings with CMS and other ... business performance needs of each market. All responsibilities extend to any new Medicare markets should Point32Health choose to expand its footprint in the future.… more
    Point32Health (01/03/25)
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  • Manager, FP&A, Medicare /Medicaid of IL

    CVS Health (Boston, MA)
    …and affordable. **Position Summary** As the Manager, FP&A, you will report directly to Director of Finance and will monitor the end to end profit & loss statements, ... data submission for the purpose of rate setting and medical trend analysis on behalf of the Health Plan....nature of this remote role, candidates must have some Medicare and/or Medicaid experience. **Required Qualifications** -5 or more… more
    CVS Health (01/17/25)
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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 ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… more
    Humana (10/29/24)
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  • Medical Director - Florida

    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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
    Humana (12/14/24)
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  • Medical Director --Claims Management

    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 (10/29/24)
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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 (11/15/24)
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  • Field Medical Director -Pulmonology

    Evolent (Boston, MA)
    …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director you will be a key member of the utilization management team. ... recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
    Evolent (12/09/24)
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  • Medical Director - Commercial…

    CVS Health (Boston, MA)
    …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity...and consistent responses to members and providers. As a Medical Director you will focus primarily on… more
    CVS Health (11/13/24)
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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 (11/29/24)
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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 (12/15/24)
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  • Associate Medical Director , Hospice

    Tufts Medicine (Lawrence, MA)
    **Tufts Medicine Care at Home** is currently seeking an **Associate Medical Director ** to join our **hospice** team in the greater **Lowell** area. This position ... or life-limiting illness. **How You'll Transform Patient Care:** + Provide direct medical care, disease management, pain and symptom management of hospice patients.… more
    Tufts Medicine (01/16/25)
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  • Associate Director , Actuarial

    Humana (Boston, MA)
    …of our caring community and help us put health first** The Associate Director , Actuarial provides actuarial support across a broad range of actuarial and business ... needs for specific product lines. The Associate Director , Actuarial requires a solid understanding of how organization capabilities interrelate across department(s).… more
    Humana (12/12/24)
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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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  • Regional Account Director

    Takeda Pharmaceuticals (Boston, MA)
    …to the best of my knowledge. **Job Description** **Regional Account Director ** **Takeda Pharmaceutical** **USA-MA-Virtual** **About the role:** Are you looking for ... you to shine? Join us as the Regional Account Director ; reporting into the Head of Corporate Accounts. This...accounts. Responsible for all books of business - Commercial, Medicare , State Medicaid and Managed Medicaid + Gain, protect… more
    Takeda Pharmaceuticals (01/11/25)
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  • Associate Director Cloud Architecture

    Humana (Boston, MA)
    …our caring community and help us put health first** The Associate Director , Cloud Architecture designs, builds, and maintains data processing architectures and ... and unstructured data to insights at enterprise scale. The Associate Director , Cloud Architecture requires an in-depth understanding of how organization capabilities… more
    Humana (11/02/24)
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  • Director of Oncology

    HCA Healthcare (Derry, NH)
    …is incentive eligible. **Introduction** Do you have the career opportunities as a Director of Oncology you want with your current employer? We have an exciting ... opportunity for you to join Parkland Medical Center which is part of the nation's leading...of colleagues. Do you want to work as a(an) Director of Oncology where your passion for creating positive… more
    HCA Healthcare (11/05/24)
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  • Web Channel and SEO Director

    CVS Health (Wellesley, MA)
    …and affordable. **Position Summary** The Web Channel Owner role for Aetna Medicare is a critical position in our Marketing organization, with accountability for ... shepherd the delivery of Digital Marketing's capabilities backlog for Aetna.com/ Medicare , AllinaHealthAetnaMedicare.com, the Shop, Buy, and Enroll tool, and more,… more
    CVS Health (12/13/24)
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  • Director , Insurance Strategy

    Humana (Boston, MA)
    …in the country. **Location:** remote The Insurance Strategy team supports Humana's Medicare and Medicaid lines of business. This business unit, Humana's largest, ... strategy for the business unit, evolving key dimensions of the Medicare Advantage growth strategy, developing a refreshed membership acquisition strategy, assessing… more
    Humana (12/21/24)
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