- Elevance Health (Smithfield, RI)
- ** Medicare Medical Director - Part time** Location: This role requires associates to be in-office 3 days per week, fostering collaboration and ... be able to work Eastern Time Zone hours. The ** Medicare Medical Director ** is responsible...specific position is $125,118 to $214,488. Prorated based on part -time hours. Locations: Illinois, Washington DC, New York In… more
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health ... claims and preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
- Humana (Providence, RI)
- **Become 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 works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Providence, RI)
- **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 (Providence, RI)
- **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 (Providence, RI)
- **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
- Evolent (Providence, RI)
- …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 (Providence, RI)
- …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. ... per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Providence, RI)
- …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. ... timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Humana (Providence, RI)
- **Become a part of our caring community and help us...high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality ... rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40...management, health outcomes, patient experience, and plan operations. The Director , Stars HOS Improvement and Operations is responsible for… more
- Evolent (Providence, RI)
- …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... in Cardiology** (with Cardiology training and clinical experience). + **Unrestricted medical license** in the state of residence and willingness to obtain… more
- Hartford HealthCare (Norwich, CT)
- …we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network. Position Summary: The Director ... oversight for the overall operations of the Care Coordination department. The Director is responsible for the development and implementation of the case management… more
- Bayer (Mystic, CT)
- …diverse minds to make a real difference, there's only one choice.** **Associate Director - Field Reimbursement - Oncology - (Northeast USA)** **Associate Director ... HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals. Develop collaborative working… more
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Lead, Data Quality/Integrity understands end-to-end master data processes and flows and ... diverse scope and complexity ranging from moderate to substantial. The Associate Director , Data Quality/Integrity will lead and manage the HEDIS Supplemental Data… more
- Prime Therapeutics (Providence, RI)
- …and drives every decision we make. **Job Posting Title** Trade Client Relations Director - Remote **Job Description** The Trade Client Relations Director is ... responsible for the analysis, modeling and delivery of innovative pharmacy and medical rebate strategies and cost saving solutions to Prime's clients to ensure Prime… more
- Evolent (Providence, RI)
- …as we solve complex business problems. **Collaboration Opportunities:** The Director , Actuarial Services utilizes and develops analytical tools to solve ... impact on the organization and patient health. This role supports both medical cost management activities and business development efforts. **What You Will Be… more
- CenterWell (Providence, RI)
- **Become a part of our caring community and help us put health first** The IPA Coding Leader manages a diverse team responsible for ensuring clinical documentation ... Leaders to identify and influence enhancements to technology to improve the medical coder experience. + Oversees coding operations by identifying business partner… more
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** Humana is a publicly traded, Fortune 50 healthcare company with a legacy of innovation, ... the core of this evolution is Humana's Insurance Segment, which provides Medicare Advantage, Medicaid, and other health plans to millions. By integrating insurance… more
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Print Project Manager 2 will report to the Associate Director of Enterprise Print ... into new processes; flexibility in job focus. + Understanding of Centers for Medicare & Medicaid Services (CMS) guidelines. Travel: While this is a remote position,… more
- Humana (Providence, RI)
- …**Reporting Relationship:** This position reports directly to the Behavior Health Lead Medical Director . **Requirements:** . BCBA-D with Florida licensure or ... **Become a part of our caring community and help us...skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Senior Utilization… more