- Beth Israel Lahey Health (Needham, MA)
- …and leadership in quality improvement activities to enhance patient care and improve service . Additionally, the Nurse Director participates in the development of ... of programs and processes to provide necessary patient care services using appropriate resources. Inherent in the role is...contributes to ongoing changes within the organization. The Nurse Director is a role model for service … more
- Humana (Providence, RI)
- …reports to a Lead Medical Director . The Medical Director conducts post- service , inpatient care reviews for accurate billing of clinically ... , requested level of care, and/or requested site of service should be authorized at the Inpatient ...**Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided… more
- Datavant (Providence, RI)
- …SMART software experience strongly encouraged to apply **You Will:** + Conduct inpatient coding audits on medical records, utilizing ICD-10-CM, CPT, and ... to realize our bold vision for healthcare. As an ** Inpatient Auditing Specialist** you will be instrumental in addressing...results for review by the facility or CCS HIM director . + Review disagreements on APC/DRG changes with the… more
- CenterWell (Providence, RI)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare… more
- Humana (Providence, RI)
- …scenarios arise from outpatient, inpatient or post-acute care environments. The Medical Director will have discussions with external physicians by phone to ... an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare… more
- Humana (Providence, RI)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare… more
- Humana (Providence, RI)
- …processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, ... an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare… more
- Humana (Providence, RI)
- …all activities. **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other ... caring community and help us put health first The Medical Director actively uses their medical...meets compliance timelines. + Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services… more
- Humana (Providence, RI)
- …and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with… more
- Humana (Providence, RI)
- …and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with… more
- Veterans Affairs, Veterans Health Administration (Framingham, MA)
- …full time position in Boston, Massachusetts in vibrant and diverse clinics. The Medical Director is responsible for ensuring that excellent, high-quality care is ... and 49% administrative time. This person will be the Medical Director for the five VA Boston...teaching opportunities for both medical students and medical residents in the inpatient and outpatient… more
- Fallon Health (Worcester, MA)
- …LinkedIn. **Brief summary of purpose:** With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief Medical Officer will ... responses related to UM Functions and department organization structure/staffing. + Works with VP/ Medical Director to identify and prioritize the cost of care… more
- Sumitomo Pharma (Providence, RI)
- …a dynamic, highly motivated, and experienced individual for the position of Associate Director , Market Access Engagement - Rare Disease, who will act as the face ... to innovative treatments for rare diseases + Collaborate with Patient Services , specialty pharmacies, and specialty distributors to streamline access to treatment… more
- Evolent (Providence, RI)
- …Tasks are performed within the **RN/LVN/LPN** scope of practice, under the Medical Director 's direction, using independent nursing judgement and decision-making, ... identifies and refers cases that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers quality issues to UM… more
- University Medicine (East Providence, RI)
- …throughout the diverse state of Rhode Island. Brown Medicine physicians also lead many inpatient medical services at both Rhode Island and The Miriam ... Brown Medicine is a large non-profit, academic, multi-specialty medical group in Rhode Island with approximately 200...embracing all three missions that we provide a unique service to our patients, our colleagues and to the… more
- Datavant (Providence, RI)
- …appropriate letter language to author appeal letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted ... Specialist is to effectively defend utilization of available health services , review of admissions for medical necessity...+ Work directly with the provider(s) and health plan Medical Director as needed to facilitate timely… more
- Cardinal Health (Providence, RI)
- …of billing for professional (physician) services and/or hospital (technical) services . This position will also support the Director with transactional ... and adequacy of documentation and coding related to physician or hospital ( inpatient and outpatient) billing and/or medical necessity reviews. + Prepares… more
- Beth Israel Lahey Health (Westwood, MA)
- …Pharmacist is responsible for the quality assurance of the provided pharmacy services . Ensures the correct medications are dispensed to the correct patients ... medication supply in the individual work area. Participates in Pharmacy staff in- services and meetings relating to system-wide and/or health care setting programs.… more
- Merck (Providence, RI)
- …Services (HMS) Manager, Solutions Consultant, Customer Strategies and Solutions (CSS), Regional Medical Director (RMD) and other key stakeholders to share key ... input into resource allocation decisions across customers + Identifies and selects programs/ services available in the library of our Company's "resources" to address… more
- Beth Israel Lahey Health (Needham, MA)
- …difference in people's lives.** Reporting directly to the Practice Manager and Senior Director of Nursing, the Team Nurse position is responsible for performing the ... care or family medicine practice and serves as a clinical resource for the medical practice. The Team Nurse provides high quality, direct patient care in a team… more