- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance Position Summary: The Director of Provider Relations leads the strategic vision and operational execution of provider ... network performance, and ensuring compliance with regulatory standards. The Director drives initiatives that enhance operational engagement, member access, provider… more
- Commonwealth Care Alliance (Boston, MA)
- …in improvement to promote the development of a high quality team .collaboration with the broader clinical organization. - Ensures that utilization management ... training, and performance monitoring and - Leads the Utilization Management team in managing and continuously improving UM program design, policies, procedures,… more
- Commonwealth Care Alliance (Boston, MA)
- …performance improvement. The LTSS Program Manager reports to the Senior Director of Delegation Partnerships and Provider Engagement. The Provider Engagement ... team is responsible for building and maintaining relationships with...Experience (must have):** + 5+ years + Experience with Medicaid and Medicare products and programs + Experience or… more
- 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...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Boston, MA)
- …to adapt and the courage to innovate **Additional Information** Reports to the Lead Medical Director - North Central Medicaid Markets. The Medical ... caring community and help us put health first** The Medical Director relies on medical ...Medical Directors will learn North Central region state Medicaid requirements (currently VA, KY, OH, IN, WI) and… more
- Humana (Boston, MA)
- …topics to the clinical operations team and healthcare organization. The Medical Director 's work includes computer based review of moderately complex to ... and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health...Medical Directors will learn Medicare, Medicare Advantage and Medicaid requirements, and will understand how to operationalize this… more
- Humana (Boston, MA)
- …training, daily work is performed with minimal direction, but with support from other team members. The Medical Director enjoys working in a structured ... caring community and help us put health first** The Medical Director actively uses their medical...of the managed care industry including Medicare Advantage, Managed Medicaid , or other Medical management organizations, hospitals/… more
- Humana (Boston, MA)
- …outcomes, consumer experiences and a highly engaged team culture **Additional Information** The medical director reports to a Lead Medical Director . ... caring community and help us put health first The Medical Director actively uses their medical...of integrity, professionalism, resourcefulness, and enjoy working in a team -based environment. Medical Directors support Humana value… more
- 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 (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 ... and will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical … more
- Humana (Boston, MA)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture + Knowledge and experience with national guidelines… more
- Humana (Boston, MA)
- …home health, SNF, DME, dual Medicare/ Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether ... caring community and help us put health first** The Medical Director relies on fundamentals of CMS...consistency in outcomes, consumer experiences, and a highly engaged team culture** + **Knowledge and experience with national guidelines… more
- CenterWell (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical … more
- Evolent (Boston, MA)
- …meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Evolent (Boston, MA)
- …for 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 . We can offer you a meaningful way to...per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to… more
- 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...teaching and consultation to other members of the multidisciplinary team , including students, if assigned. + Provides collaborative leadership… more
- Evolent (Boston, MA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management ... team . We can offer you a meaningful way to...timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to… more
- Evolent (Boston, MA)
- …recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management ... will be a key member of the utilization management team . We can offer you a meaningful way to...Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance Position Summary: The Director of Provider Relations leads the strategic vision and operational execution of provider ... network performance, and ensuring compliance with regulatory standards. The Director drives initiatives that enhance operational engagement, member access, provider… more
- Bear Mountain Health Care (Boston, MA)
- …Healthcare is looking for an experienced, motivated and creative Assistant Director of Nursing(ADON)/Infection Control (ICP) for our Mattapan, MA location. As ... the nursing department. You will work closely with the Director of Nursing to improve the quality of patient...quality of patient care and services provided by your team . POSITION REQUIREMENTS: . Must have a current unencumbered… more
