- 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 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 fundamentals of CMS Medicare Guidance on following ... health, DME, skilled nursing facility and waiver requests. The Medical Director provides medical interpretation...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Humana (Providence, RI)
- …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to ... 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 (Providence, RI)
- …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to ... 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 (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)
- …business. Join Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of the Medical ... questions. + Reviews statistical sample of cases for Field Medical Director audits and makes recommendations into...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… 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)
- …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 ... 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
- 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
- Point32Health (Canton, MA)
- …service lines for Medicare , Medicaid and Commercial product lines. The Director also identifies opportunities to reduce medical and administrative costs by ... to our members, partners, colleagues and communities. **Job Summary** The Director , Ancillary Contracting leads the development and management of Point32Health's… 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
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid ... clinical practices and processes for clinical community within the enterprise. The Director , Clinical Strategy and Practice requires an in-depth understanding of how… more
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Associate Director , Software Engineering leads software development application team ... based on business requirements. The Associate Director , Software Engineering requires a solid understanding of how...protect member PHI / HIPAA information. Interview Format As part of our hiring process for this opportunity, we… more
- BAYADA Home Health Care (Canton, MA)
- BAYADA Home Health Care is currently seeking an **Associate Director ** to join our **Canton, MA Medicare certified Home Health Senior Living Office.** If you are ... an exciting career opportunity in a growing industry, a Director role might be the position for you. This...in this dynamic, entrepreneurial environment and become an integral part of a caring, professional team that is instrumental… more
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Resolution team handles all complaints for Humana, including formal grievances, appeals, ... experience for our associates, members and providers. As the Resolution Team Operations Director ( Director , Grievance and Appeals), you will be accountable for… more
- Humana (Providence, RI)
- **Become a part of our caring community and help us put health first** The Director , Risk Adjustment Strategy Advancement will provide business intelligence and ... for business segments and the company at large. The Director , Risk Adjustment Strategy Advancement requires an in-depth understanding...protect member PHI / HIPAA information **Interview Format** As part of our hiring process, we will be using… 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
- Prime Therapeutics (Providence, RI)
- …our passion and drives every decision we make. **Job Posting Title** Sr Director Analytics **Job Description** The Senior Director Analytics is responsible for ... knowledge of pharmacy performance analytics, waste analytics, Specialty Pharmacy and Medical Benefits + Ability to identify and implement consultative services… more